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Nt X12 837 Health Care Claim Dental Companion Document Audience Companion documents are intended for information technology and/or systems staff who will be coding billing systems or software for compliance with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). Purpose of Companion Documents The information contained in this companion document applies to ForwardHealth which includes the following programs: BadgerCare Plus, Wisconsin Medicaid, SeniorCare, Wiscon.
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Ada FAQ
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X12 HIPAA 837D Dental Claim The EDI 837 transaction set is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information. The claim information included amounts to the following, for a single care encounter between patient and provider: A description of the patient.
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What is an 837 File? An 837 file is an electronic file that contains patient claim information. This file is submitted to an insurance company or to a clearinghouse instead of printing and mailing a paper claim.
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Within healthcare, the main X12 healthcare transactions are 834 (benefit enrollment), 835 (payment), 837 (claim), and 276/277 (claim status). The EDI 834 healthcare transaction specifically handles patient enrollment and maintenance functions.
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ERA/835 Files The Electronic Remittance Advice (ERA), or 835, is the electronic transaction that provides claim payment information. These files are used by practices, facilities, and billing companies to auto-post claim payments into their systems.
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The EDI 837 file plays a critical role in streamlining the claims submission and processing workflow. It eliminates the need for manual claim form filling, reduces errors, accelerates claims processing, and expedites reimbursement for healthcare providers.
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