837 Health Care Claim

This Draft Standard for Trial Use contains the format and establishes the data contents of the Health Care Claim Transaction Set (837) for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to submit health care claim billing information 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. 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. The payer refers to a third party entity that pays claims or administers the insurance product or benefit or both. For example, a payer may be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), etc.) or an entity such as a third party administrator (TPA) or third party organization (TPO) that may be contracted by one of those groups.

Transaction Set 837 is not present in X12 Release 3020. Please switch to one of the following releases to view the documentation.
Appears in
  1. Version 8
    1. X12 Release 8050 Released 2024
    2. X12 Release 8040 Released 2023
    3. X12 Release 8030 Released 2022
    4. X12 Release 8020 Released 2021
    5. X12 Release 8010 Released 2020
  2. Version 7
    1. X12 Release 7060 Released 2019
    2. X12 Release 7050 Released 2018
    3. X12 Release 7040 Released 2017
    4. X12 Release 7030 Released 2016
    5. X12 Release 7020 Released 2015
    6. X12 Release 7010 Released 2014
  3. Version 6
    1. X12 Release 6050 Released 2013
    2. X12 Release 6040 Released 2012
    3. X12 Release 6030 Released 2011
    4. X12 Release 6020 Released 2010
    5. X12 Release 6010 Released 2009
  4. Version 5
    1. X12 Release 5050 Released 2008
    2. X12 Release 5040 Released 2007
    3. X12 Release 5030 Released 2006
    4. X12 Release 5020 Released 2005
    5. X12 Release 5010 Released 2004
  5. Version 4
    1. X12 Release 4060 Released 2003
    2. X12 Release 4050 Released 2002
    3. X12 Release 4040 Released 2001
    4. X12 Release 4030 Released 2000
    5. X12 Release 4020 Released 1999
    6. X12 Release 4010 Released 1998
  6. Version 3
    1. X12 Release 3070 Released 1997
    2. X12 Release 3060 Released 1996
    3. X12 Release 3050 Released 1995
    4. X12 Release 3040 Released 1994
    5. X12 Release 3030 Released 1993

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