ASC X12 837: Health Care Claim Transaction

The ASC X12 837 transaction is either a request for payment from a provider to an insurance company or a statement of the proposed services sent as a predetermination. The ASC X12 837 transaction can also be used to report encounter information. There are three different types of claims: Dental claims, Medical claims, and Hospital claims. Each claim type is sufficiently different to warrant its own transaction. The Dental claim is referred to as the ASC X12 Health Care Claim: Dental (837D); the Medical claim is referred to as the ASC X12 Health Care Claim: Professional (837P) (Professional); and the hospital claim is referred to as the ASC X12 Health Care Claim: Institutional (837I). Claims may be sent either in batches or individually. Individual claims are usually only sent when requesting Real Time Adjudication (RTA).