A federal act, HIPAA goes beyond usual healthcare services to ensure that individuals of US get health insurance, portability and accountability in terms of privacy. The act ensures that the health insurance claims would be filed and claimed quicker, healthcare information would be kept secure, its confidentiality ensured while the administrative costs would be controlled to ensure productivity.
The act is divided into three parts and includes- portability, which allows individuals to carry health insurance from one job to the other, administrative simplification, which establishes a common set of rules or standards for transmitting, receiving and maintaining information along with privacy or protection f individually identifiable healthcare information. This act requires filling of different forms, such as HIPPA 837 which assures high standard services for individuals across the country.
The HIPPA 837 is a standard format form which is used by healthcare professionals as well as suppliers for transmission of claims. This includes insurance claims, which are filed electronically. Its earlier version was the Form CMS-1500, which served as a standard paper claim form to bill Medicare. Today, the 837 form is used for billing Medicare Fee for Service or FFS contractors. Apart from Medicare, this form is also use for billing different government agencies and private insurance companies.
This claim format includes standard information of a single care encounter (between a patient and a healthcare provider). In the HIPPA 837, information related to the description of the patient, the condition of which service or treatment is provided along with the cost of treatment is included. Healthcare providers are supposed to comply with the version 5010 of EDI transactions to ensure transparency and security of the information.
The form is divided into three different groups. Healthcare providers or billing companies have to use different versions accordingly. For instance 837P is used by professionals, 837I is used by institutions and 837D should be used by dentists. A single version 837 was earlier used by retail pharmacies, but it is no longer in use.
Managing EDI transactions is easier with the form, which is sent by providers to the payers, including insurance companies, health maintenance organizations or other private providers (such as a relative). It is also used for billing government agencies and can be sent directly or indirectly via clearinghouses.
To ensure that you get efficient and effective EDI Healthcare transaction services, make sure that you choose a company that offers reliable solutions, such as HIPAA Claim Master for 837, which can be used for handling all electronic claims and transactions for this form and provides features such as imaging, manual claim entry, EDI creation form database and database export. Prefer to get services from an organization that also provides Enrollment Master Services for 834, Claim Payment Master Services, eligibility responder facilities, authorizer and claim status checker facilities to get holistic range of services as a healthcare provider.