Which format is used to submit claims electronically to a third party payer?

Which format is used to submit claims electronically to a third party payer?

• A. 837
• B. 835
• C. 1500
• D. 2700

Answer: (A)

Electronic submission of health care claims to a payer uses the 837 transaction set. This HIPAA-mandated format standardizes the data structure for claims, whether professional, institutional, or dental, so that payers can efficiently receive, process, and adjudicate the claim. It carries details like patient and provider identifiers, service lines, diagnoses, procedures, dates, and charges in a consistent, machine-readable format. The other formats serve different purposes: the remittance advice format (835) is used to convey how a claim was paid or denied, not to submit the claim itself; the paper form (CMS-1500) represents the traditional hard-copy claim form used before electronic submission; and the remaining option does not represent the electronic claim submission format.

Electronic submission of health care claims to a payer uses the 837 transaction set. This HIPAA-mandated format standardizes the data structure for claims, whether professional, institutional, or dental, so that payers can efficiently receive, process, and adjudicate the claim. It carries details like patient and provider identifiers, service lines, diagnoses, procedures, dates, and charges in a consistent, machine-readable format.

The other formats serve different purposes: the remittance advice format (835) is used to convey how a claim was paid or denied, not to submit the claim itself; the paper form (CMS-1500) represents the traditional hard-copy claim form used before electronic submission; and the remaining option does not represent the electronic claim submission format.