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Back   Real-time Claim Processing Model (005050X289)

Purpose

The Real-time Claim Processing Model Type 2 Technical Report describes the use of the ASC X12 Health Care Claim Payment/Advice (835) transaction set for the following business usage:
  • Respond to a real-time health care claim or encounter.

Primary Trading Partners

Receving trading partners include:
  • Hospitals
  • Nursing homes
  • Laboratories
  • Physicians
  • Dentists
  • and allied professional groupsThird Party
Sending trading partners include:
  • Administrators (TPAs)
  • Service corporations
  • State and federal agencies and their contractors
  • Plan purchasers, and any other entities that process real-time health care claims or encounters
Other business partners affiliated with the 835 billing services:
  • Consulting services
  • Vendors of systems, software and EDI translators
  • EDI network intermediaries such as Automated Clearing Houses, value-added networks, and telecommunication services

References

This is the first implementation guide for this business purpose.

Additional Information

Registered 6/25/2008
Transaction Set ID 835 Standard Version 005050
ASC X12 DM# Owning Group X12N/TGB/WG3