HIPAA transactions were developed with the intent to reduce overall administrative costs for the healthcare industry. This is accomplished in two ways, by developing a standard that can be used to conduct these transactions consistently under all similar conditions and trading partners to create transactions that automate previously manual or semi-manual processes.
This article will discuss how these transactions can be used to support the processing and follow up of claims.
The first step in claims processing is the creation of the claim file itself, the 837i (institutional) and the 837p (professional). These files must contain all recently produced claims of each type that are destined for a specific entity. At our company, we use the term receiver to represent the target of these files. Receiver is distinguished from payer in that a receiver may receive claims for multiple payers in a single file. For example, a clearinghouse like Emdeon or Availity. In other cases, the receiver may represent a single payer, or even a sub-classification of a payer, like Medicare Part A and Medicare Part B. Continue reading