Using 835 & 837 Transactions Sets for Healthcare Claims and Remittance

Using 835 & 837 Transactions Sets for Healthcare Claims and Remittance

The 835 and 837 transaction sets are two electronic documents vital to healthcare and commissioned by HIPAA 5010 requirements. They are an essential part of the hospital payment process, but one might not fully understand exactly what they are.

835

The 835-transaction set, aka the Health Care Claim Payment and Remittance Advice, is the electronic transmission of healthcare payment/benefit information. It’s mainly used by healthcare insurance plans to make payments to providers, provide Explanations of Benefits, or both.

When a healthcare service provider submits an 837 Health Care Claim, the insurance plan uses the 835 to help detail the payment to that claim.

837

The 837-transaction set is the electronic submission of healthcare claim information. Healthcare service providers are required to be compliant with HIPAA EDI standards when submitting medical claims to payers in electronic format.

Under those standards the 837 transaction groups are broken down into three groups: for professionals, physicians or those providing care, for institutions, hospitals, or locations where care is provided, and for dental practices. Providers send the 837-transactions sets to payers but not retail pharmacies.

Do You Need Help Reading 835 and 837 Transactions?

An 835 document may not automatically match up with a specific 837. It’s common for multiple 835 transactions be used in response to a single 837, or one 835 to address multiple 837 submissions. It can be extremely complex and difficult to manage. As a result, the 835 is important to healthcare providers to help track received payments for services billed and provided.

With Medcom Solutions professional services and our ability to parse 835 & 837 raw data we can dive into the detail of your 835 payment & 837 submission files to help you answer questions like:

  • What revenue cycle issues may be impeding accurate payments to your facility?
  • How do you measure and correct breakdowns in the charge capture, coding, and billing processes?
  • Are you having any specific denial issues?
  • Is it time to reevaluate your payor contracts?

We create a report card of where you’re performing well and where there is opportunity for improvement. Also, develop a succinct roadmap of where you need to go and what actions need to be taken to achieve the greatest improvement to your bottom line. To ensure your hospital meets HIPAA 5010 requirements, no one else compares to Medcom Solutions.

Contact Medcom Solutions today to learn more!

About MedCom Solutions

MedCom Solutions creates patented technology and state-of-the-art software to help medical service providers meet rapidly escalating and changing medical billing demands. Our Chargemaster, Pricing, and Compliance solutions have yielded hundreds of millions in net revenue for healthcare providers across the country.

Learn more about our solutions or visit our homepage or contact us today!

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