Which standardized formats are used in the electronic filing of claims?

Which standardized formats are used in the electronic filing of claims?

• A. HIPAA standard transactions
• B. ICD-10-CM codes
• C. HCPCS
• D. CPT codes

Answer: (A)

Electronic claim filing relies on standardized formats set by HIPAA. These HIPAA standard transactions define how claim data is structured and transmitted between providers and payers, ensuring consistent, interoperable communication. Within those transactions, the actual codes used to describe diagnoses and procedures—ICD-10-CM, CPT, and HCPCS—appear as data elements, but they are not the filing formats themselves. The formats are the transaction sets and envelopes (for example, the 837 claim transactions and related HIPAA-standard transactions). So the best choice is HIPAA standard transactions. The other options refer to coding systems used within claims, not the filing formats.

Electronic claim filing relies on standardized formats set by HIPAA. These HIPAA standard transactions define how claim data is structured and transmitted between providers and payers, ensuring consistent, interoperable communication. Within those transactions, the actual codes used to describe diagnoses and procedures—ICD-10-CM, CPT, and HCPCS—appear as data elements, but they are not the filing formats themselves. The formats are the transaction sets and envelopes (for example, the 837 claim transactions and related HIPAA-standard transactions). So the best choice is HIPAA standard transactions. The other options refer to coding systems used within claims, not the filing formats.