How HIPAA 837 claim form similar to the cms-1500?
March 5th, 2015 - Lovisa Alvin837 claim form is a professional claim form, offering a standardized format of claim submission. The form is used by healthcare professionals and suppliers. Primarily used for transmitting healthcare claims electronically, the form has a particular format, which ensures that HIPAA requirements are met.
The form includes following-
- Description of the patient
- Patient’s medical condition(s) for which treatment is was provided
- Services that were included in the treatment and the overall costs
While HIPAA 837 claim form is a standard format for transmitting healthcare claims electronically, CMS-1500 is the paper based claim form that is billed to Medicare (government organization) Fee for Service facilities. While the forms differ on their modes, both of them are usually suitable for billing various government institutions and several private insurers. In general, CMS-1500 claim form is used by non-institutional medical providers. Apart from Medicare carriers, these forms may be billed to durable medical equipment provider for waiving electronic claims.
837 claim form is basically involved in submission of healthcare claims or encounter information. But it isn’t used for retail pharmacy claims, for which EDI Retail Pharmacy Claim Transaction is used. Briefly stating, it can be sent from providers of healthcare services to payers of the bill, through billers or claim settling clearinghouses. It can also be used for forwarding healthcare information or billing information to concerned parties, ensuring coordination between healthcare service and the specific insurance agency. Alike CMS-1500, 837is also a uniform professional insurance claim system.
Form CMS-1500 requires information like Patient’s Name and Address, employer’s name and company, information regarding insurance policy or the plan name that’s been used along with necessary details about diagnosis or nature of the illness or injury.
While Form CMS-1500 has a set format by the government, for 837 form, the format may change and EDI Converters may have to be used to promote privacy of patient information and ensuring proper channel for dealing with the claims. This claim is electronically transmitted through data packets, with direct transmission from provider’s computer software to the Medicare’s contractor or health insurance providers. Claims are then supposed to pass over initial edits and edits against implementation to avoid error issues. Once that’s done, the claims are rejected, denied or accepted according to the insurance plan or information provided about the patient. The same information is then relayed back to the provider or submitter of the claim.
So, if you opt for 837 forms, ensure that the providers must comply with ASC X12N 837 Institutional Guide and bill a carrier for claims other than those on prescription drugs and pharmacies. Briefly stating, 837 Claims and CMS-1500 claims work concurrently with each other.
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