Health Care Claim: Professional

Based on the Accredited Standards Committee (ASC) X12 format, the 837 can be used to submit health-care claim billing information, encounter information, or both, from providers of health-care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health-care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health-care services within a specific health care/insurance industry segment. For purposes of this standard, providers of health care products or services may include entities such as physicians, hospitals and other medical facilities or suppliers, dentists, and pharmacies as well as entities providing medical information to meet regulatory requirements. The payer refers to a third-party entity that pays claims or administers the insurance product or benefit and/or does both.