What is an EDI 837?

The EDI 837 is used in HIPAA EDI transactions. The EDI 837 Healthcare Claim concerns the submission of healthcare claim billing information, encounter information or both. This transaction is usually sent by a provider, such as a primary care physician’s office, hospital, or other healthcare facility, to a healthcare insurer. Subtypes of EDI 837 include: 

  • EDI 837P: For care received outpatient, both medical- and vision-related. 
  • EDI 837I: For institutional care like a hospital stay or emergency room visit. 
  • EDI 837D: For dental care, including dental specialty care like orthodontics and periodontics. 

EDI 837 documents follow the x12 format set by the American National Standards Institute (ANSI), a not-for-profit organization that regulates EDI formats in the U.S. 

Infographic showing how EDI works

What are the Essential Components of EDI 837?

Much like a paper catalog, EDI 837 needs to include specific details about each product available to trading partners. Key elements of EDI 837 include: 

  • Patient information, such as name and date of birth (DOB) 
  • The reason for the patient visit 
  • The services rendered or treatment provided 
  • Total cost of the treatment 

How do I Use EDI 837?

Like any EDI document, the EDI 837 contains information that is typically found in paperwork or on the in-house computer systems. The first step in submitting an EDI 837 is to translate the "human readable" format into an EDI standard. In order to achieve this, the data must first be placed into an EDI translator. This can be done manually or through some form of data integration with your in-house system.  

The process of converting the raw data into an EDI 837 begins once the EDI 837 data is in the EDI translator. This conversion process follows specific guidelines set forth by the ASC X12 standard that covers EDI data used in several industries, including HIPAA-based EDI transactions like the EDI 837.   

Once your EDI 837 is formatted in an industry-standard form, the next step is to transmit the EDI 837 to its intended recipient. This transmission can be done using one of two ways - directly to the receiver or through a type of clearing house known as a Value-Added Network (VAN). In the second case, the EDI 837 is sent to the VAN in a secure form, often through a dial-up connection, and is then routed to the proper destination by the VAN.

The direct communication method is a popular alternative means of sending the EDI 837 - like the AS2 protocol that uses Internet technologies to send an encrypted EDI 837 over secure communications.  Regardless of the method used, once the EDI 837 arrives at its intended destination, the reverse process takes place to decode the EDI 837 into a document that is understandable and usable by the recipient.

What are the Benefits of EDI 837?

Healthcare claims sent via EDI offer several benefits over other methods, such as by mail or phone. The data encryption provided by more value-added networks is key to safeguarding HIPPA-protected patient information. Traditionally, processing claims has been a time-consuming and labor-intensive process for both providers and insurers; sending claims documents via EDI helps cut down on this time, while ensuring information accuracy. This also helps speed up the payment of claims. 

Like all EDI transactions, the EDI 837, is made up of segments and codes that are difficult to understand unless you are an EDI expert. For this reason, a more popular way of building your EDI 837 is to use EDI integration. Through EDI integration the data required for the EDI 837 is dynamically pulled from your in-house computer system and sent to the EDI 837 in your EDI translator.  

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