Electronic processing of insurance claims and payment data Forms for Bronx

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FAQ

The 837P (Professional) is the standard format health care professionals and suppliers use to send health care claims electronically. The ANSI ASC X12N 837P (Professional) Version 5010A1 is the current electronic claim version.

The two most common claim forms are the CMS-1500 and the UB-04. The UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in-patient, and other facility providers. A specific facility provider of service may also utilize this type of form.

Form CMS-1500 is the standard paper claim form used to bill an insurance for rendered services and supplies. It provides information about the client, their corresponding insurance policy, and their diagnosis and treatment. Additionally, most insurances allow you to send an electronic version, called an 837 file.

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. The 837-transaction set is the electronic submission of healthcare claim information.

An 837 file is an electronic file that contains patient claim information. This file is submitted to an insurance company or to a clearinghouse instead of printing and mailing a paper claim. The data in an 837 file is called a Transaction Set.

An electronic claim is a paperless patient claim form generated by computer software that is transmitted electronically over telephone or computer connection to a health insurer or other third-party payer (payer) for processing and payment.