HIPAA X12 837 Health Care Claim: Professional (837P) are

Electronic form used to send a claim for payment for physician services to primary and secondary payers.

HIPAA X12 837 Health Care Claim: Professional (837P) are based one

the CMS-1500, a paper claim form for physician services.

HIPAA X12 837 Health Care Claim: Professional (837P) are Commonly Called

the “837P” or “HIPAA claim”

The National Uniform Claim Committee

The National Uniform Claim Committee (NUCC)

The organization responsible for claim content

CMS-1500 (02/12) & 5010A1 version

newest format for EDI transactions: Provides more room for ICD-10 codes.

current paper claim form approved by the NUCC

data entry area in the upper right portion of CMS-1500

Four-line address of the payer if address is only three lines

the third line must be left blank. Do not use Punctuation

healthcare professional who provides health services reported on a claim

provider of health services reported on a claim

Provider of health services reported on a claim:

Person or organization sending a HIPAA claim. Could be the same person as the rendering and pay-to provider

Healthcare professional who provides health services reported on a claim

Physician or other entity (such as a lab) who treated or cared for the patient.

entity (person or organization) that will receive payment for services on a claim

Physician that refers the patient to another provider or Specialist

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MED112 Chapter 7

Question	Answer
HIPAA X12 837 Health Care Claim: Professional (837P) are	Electronic form used to send a claim for payment for physician services to primary and secondary payers.
HIPAA X12 837 Health Care Claim: Professional (837P) are mandated by	HIPAA
HIPAA X12 837 Health Care Claim: Professional (837P) are based one	the CMS-1500, a paper claim form for physician services.
HIPAA X12 837 Health Care Claim: Professional (837P) are Commonly Called	the “837P” or “HIPAA claim”
NUCC	The National Uniform Claim Committee
The National Uniform Claim Committee (NUCC)	The organization responsible for claim content
NUCC Claim Content	CMS-1500 (02/12) & 5010A1 version
5010A1 version	newest format for EDI transactions: Provides more room for ICD-10 codes.
CMS-1500 (02/12)	current paper claim form approved by the NUCC
Carrier block	data entry area in the upper right portion of CMS-1500
Four-line address of the payer if address is only three lines	the third line must be left blank. Do not use Punctuation
Rendering provider	healthcare professional who provides health services reported on a claim
Billing provider	provider of health services reported on a claim
Provider of health services reported on a claim:	Person or organization sending a HIPAA claim. Could be the same person as the rendering and pay-to provider
Healthcare professional who provides health services reported on a claim	Physician or other entity (such as a lab) who treated or cared for the patient.
Pay-to provider	entity (person or organization) that will receive payment for services on a claim
Referring provider.	Physician that refers the patient to another provider or Specialist
Claim accepted by a health plan for adjudication	Clean Claim
Unique number assigned by the sender to each service line on a claim	Line item control number
POS	Place of Service
3 Methods for HIPAA
EMG	Emergency
DDE	Direct Data Entry

Created by: user-1990156

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