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Back   Health Care Claim: Professional (005010X222)

Purpose

The Health Care Claim: Professional Implementation Guide describes the use of the ANSI ASC X12 Health Care Claim (837) transaction set for the following business usage:
  • Submit and transfer professional claims and encounters from health care providers to health care payers and between payers

Primary Trading Partners

Trading partners include:
  • Health care providers, such as physicians, practitioners, and suppliers
  • Health care and property/casualty payers, such as private health care insurers and HMOs
  • Clearinghouses, repricers, VANS, etc.

    References

    • Health Care Claim: Professional (003070X066)
    • Health Care Claim: Professional (004010X098)
    • Health Care Claim: Professional (004050X143)
    • Health Care Claim: Professional (004060X194)

    Coordination

    • ANSI ASC X12N TG2/WG2 (Health Care Claims) developers for the dental, institutional, and workers’ compensation medical bill implementation guides.
    • ANSI ASC X12N TG2/WG3 (Health Care Claim Payment)
    • ANSI ASC X12N TG2/WG4 (Health Care Enrollments)
    • ANSI ASC X12N TG1/WG3 (Workers’ Compensation and Disability

    Additional Information

    Registered 10/2/2003 Published 5/5/2006
    Transaction Set ID 837 Standard Version 005010
    ASC X12 DM# Owning Group X12N/TG2/WG2