Which code represents the electronic claim submission format used in healthcare payer networks?

Which code represents the electronic claim submission format used in healthcare payer networks?

• A. 837
• B. 835
• C. 270
• D. 271

Answer: (A)

The main concept is that submitting claims electronically to payer networks uses the 837 transaction set. This HIPAA-standard format carries all the claim data needed for processing—patient demographics, provider details, service lines, CPT/HCPCS and ICD codes, charges, and adjustments. There are variations of this format: 837 professional for professional/clinic claims, 837 institutional for facility or hospital claims, and 837 dental for dental claims. The other options refer to different exchanges: 835 is for electronic remittance advice and payment information, while 270 is a eligibility inquiry and 271 is the eligibility/benefits response. Because 837 is specifically designed for claim submissions to payers, it is the correct choice.

The main concept is that submitting claims electronically to payer networks uses the 837 transaction set. This HIPAA-standard format carries all the claim data needed for processing—patient demographics, provider details, service lines, CPT/HCPCS and ICD codes, charges, and adjustments. There are variations of this format: 837 professional for professional/clinic claims, 837 institutional for facility or hospital claims, and 837 dental for dental claims. The other options refer to different exchanges: 835 is for electronic remittance advice and payment information, while 270 is a eligibility inquiry and 271 is the eligibility/benefits response. Because 837 is specifically designed for claim submissions to payers, it is the correct choice.