The 835 and 837 transaction sets are two electronic documents vital to healthcare and commissioned by HIPAA 5010 requirements. They are an essential part of the hospital payment process, but one might not fully understand exactly what they are.
835
The 835-transaction set, aka the Health Care Claim Payment and Remittance Advice, is the electronic transmission of healthcare payment/benefit information. It’s mainly used by healthcare insurance plans to make payments to providers, provide Explanations of Benefits, or both.
When a healthcare service provider submits an 837 Health Care Claim, the insurance plan uses the 835 to help detail the payment to that claim.
837
The 837-transaction set is the electronic submission of healthcare claim information. Healthcare service providers are required to be compliant with HIPAA EDI standards when submitting medical claims to payers in electronic format.
Under those standards the 837 transaction groups are broken down into three groups: for professionals, for institutions and for dental practices. Providers send the 837-transaction sets to payers but not retail pharmacies.
Do You Need Help Reading 835 and 837 Transactions?
An 835 document may not automatically match up with a specific 837. It’s common for multiple 835 transactions be used in response to a single 837, or one 835 to address multiple 837 submissions. It can be extremely complex and difficult to manage. As a result, the 835 is important to healthcare providers to help track received payments for services billed and provided.
With Medcom Solutions professional services and our ability to parse 835 & 837 raw data we can dive into the detail of your 835 payment & 837 submission files to help you answer questions like:
We create a report card of where you’re performing well and where there is opportunity for improvement. Also, develop a succinct roadmap of where you need to go and what actions need to be taken to achieve the greatest improvement to your bottom line. To ensure your hospital meets HIPAA 5010 requirements, no one else compares to Medcom Solutions.
Contact Medcom Solutions today to learn more!
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