Differences between 837P professional, 837D dental, and 837I institutional claims

There are three major types of electronic healthcare claims:

• 837P professional claims

• 837D dental claims

• 837I institutional claims

Each bills for a different type of care. This guide covers how claim types differ at a high level and when to use each.

Differences at a glance

The following table outlines the major differences between each claim type.

Medical vs. dental claims

Both professional and institutional claims are considered medical claims. They’re typically billed to a medical insurer – called a payer – such as Cigna or Medicare.

If you’re billing for a dental service, like a cleaning, filling, or braces, you’d typically use a dental claim. Dental claims are usually sent to a separate dental payer or plan rather than a medical one.

For example, someone could be insured by a medical plan like UnitedHealthcare for medical care and a separate dental plan like Delta Dental for dental services.

Even payers who offer both medical and dental insurance do so through different plans and often use different subsidiary payer IDs.

All three claim types – professional, institutional, and dental – are considered healthcare claims.

Professional vs. institutional claims

Professional and institutional claims both bill for medical services. The key difference comes down to what specific type of service is being billed.

Professional claims are used to bill for an individual provider’s services. Think of things like a doctor’s exam or a therapist’s session.

Institutional claims are used to bill for services, equipment, or resources from a hospital or other medical facility. Think nursing staff, use of an EKG machine, or an inpatient hospital stay.

The same visit can result in both professional and institutional claims.
For example, if a patient has surgery at a hospital:

• The surgeon’s services may be billed using a professional claim.

• The operating room, hospital stay, and other services may be billed using an institutional claim.

Even though care happened during the same encounter at the same time and place, the services are billed separately.

Procedure codes

One of the key differentiators between each claim type is the type of procedure codes used.

Regardless of claim type, each claim contains one or more service lines that precisely describe the type of service or care provided.

Each service line includes a procedure or revenue code that tells the payer what was done. The specific code set used depends on the claim type.

What does the “837” part mean?

“837” is a reference to the claim’s underlying X12 transaction type.

HIPAA is a U.S. federal law that, among other things, requires that certain electronic healthcare transactions – including claims – use X12 EDI. 

837 refers to the X12 Health Care Claim transaction set – the HIPAA-mandated spec for electronic healthcare claims.

X12 implementation guides
The letter at the end of 837 (P, I, or D) refers to the HIPAA-adopted X12 implementation guide for each claim type:

• 837P for professional claims

• 837D for dental claims

• 837I for institutional claims

By itself, X12’s 837 Health Care Claim transaction set is too broad for practical use.

The implementation guides lay out more specific rules for how each type of claim must be submitted. For example, the 837P implementation guide requires CPT and HCPCS procedure codes for professional claims. Institutional claims require revenue codes to describe facility charges.

Stedi uses the implementation guides to build our JSON claim submission APIs, which translate JSON requests into valid 837 X12 transactions. We also use them to create edits and repairs, which catch – and, when possible, fix – errors that could cause payment delays for the provider.

Everyday usage
People often refer to a claim type by its transaction set. For example, you may hear people refer to an electronic professional claim as an “837P” or an “837P professional claim.”

ERAs

835 Electronic Remittance Advice (ERAs), also called remits, explain what a payer (insurer) paid a provider and why. A single ERA can cover multiple claims, showing which were paid, how much was paid, and which were denied – along with the reason.

ERAs use the same transaction set, regardless of whether the submitted claim was an 837P professional, 837D dental, or 837I institutional claim. Unlike claims, there aren’t separate implementation guides for ERAs.

The ERA references the claim paid using the claim’s patient control number. The ERA also includes a claim filing indicator code, which indicates the type of insurance coverage the claim was processed under, and includes line-level information for each procedure or revenue code submitted in the claim.

Transaction enrollment requirements

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer.

Payers always require transaction enrollments for ERAs. For claims and other transaction types, it depends on the payer.

Enrollment requirements by claim type
Most payers don’t require transaction enrollment for claim submission. 

You can check the payer’s enrollment requirements using the Stedi Payer Network or Payers API. Stedi breaks down enrollment requirements by claim type. For example, in Payers API responses:

{
  "payer": {
    "displayName": "Medicaid California Medi-Cal",
    "primaryPayerId": "100065",
    "transactionSupport": {
      "professionalClaimSubmission": "ENROLLMENT_REQUIRED",   // Enrollment required for 837P professional claims
      "institutionalClaimSubmission": "ENROLLMENT_REQUIRED",  // Enrollment required for 837I institutional claims
      ...
    },
    ...
  }
}

Transaction support
In many cases, a payer may only accept one or two claim types. For example, a dental payer may only accept dental claims. Similarly, a medical payer may only accept professional and institutional claims.

You can check transaction support using the Stedi Payer Network or Payers API. For example, in Payers API responses:

{
  "payer": {
    ...
    "transactionSupport": {
      "professionalClaimSubmission": "SUPPORTED",              // 837P professional claims are supported (no enrollment required)
      "institutionalClaimSubmission": "ENROLLMENT_REQUIRED",   // 837I institutional claims (with enrollment)
      "dentalClaimSubmission": "NOT_SUPPORTED",                // 837D dental claims are not supported
      ...
    },
    ...
  }
}

Claim attachments

Claim attachments are additional documents that help justify or validate a claim.

Some payers require attachments to approve claims for specific services. Claim attachments show a service occurred or was needed. They can include X-rays, treatment plans, or itemized bills.

Support by claim type
Claim attachments are submitted as separate X12 275 transactions. The supported methods for submitting the 275 claim attachment depend on the claim type:

• 837P professional claims: The Stedi portal’s CMS-1500 form, API, and SFTP

• 837D dental claims: API and SFTP

• 837I institutional claims: SFTP

For more details, see our Claim attachment docs.

Test workflows

Stedi’s test claim workflow supports each claim type – professional, institutional, and dental.

You can submit test claims of any type to the Stedi Test Payer (Payer ID: STEDI) using our API or SFTP. You’ll receive back 277CA claim acknowledgements and a realistic mock ERA. The mock ERAs mirror the type of electronic remittance you’d receive from payers in production. You can also submit test professional claims and complete the workflow using the Stedi portal’s CMS-1500 form.

If you’re migrating to Stedi, you can use this workflow to validate your setup before going live. If you’re already a Stedi customer, you can use the workflow to build integration tests that confirm your systems handle payment data correctly.

Pricing

Stedi charges the same price for each claim submission, regardless of type. See our pricing page.

Process claims with Stedi

Stedi helps you process and track claims through every part of the lifecycle – from submission to remittance.

You can start for free. Our Basic plan includes 100 free claim submissions, ERAs, and claim status checks each month.

Signup takes less than two minutes. No credit card is required.