Healthcare Industry and the EDI 835 and EDI 837 Transaction Sets

Question:  Hi Louisa, I work in the Healthcare Industry and have been recently asked by one of our trading partners if we can handle the EDI 837 and EDI 835 Transaction Sets. Do you know what these are?

Answer:  Hi Stephanie, thanks for your question. I will answer separately on both the EDI 837 and EDI 835 as follows:

The EDI Health Care Claim Transaction set (EDI 837) is used to submit health care claim billing information, encounter information, or both. It can be sent from providers of healthcare 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 co-ordination of benefits is required.

EDI Health Care Claim Payment/Advice Transaction Set (EDI 835) can be used to make a payment, send an Explanation of Benefits (EOB), send an Explanation of Payments (EOP) remittance advice, or make a payment and send an EOP remittance advice only from a health insurer to a health care provider either directly or via a financial institution.
These transaction sets can be quite complicated to set up and if you are new to EDI, I would recommend that you outsource this function to an established 3rd party EDI provider. For further details on EDI in the Healthcare Industry and the EDI 837 and EDI 835 transactions sets, please visit www.B2BGateway.Net or call (401) 491-9595.