Thursday, 3 July 2014

What’s the difference between 837 Institutional, Professional, Dental?

What’s the difference between 837 Institutional, Professional, Dental?

Dear Blog Readers – HIPAA Friday To You! Last week we defined how other HIPAA EDI transactions may or may not to other 837 transactions. Today is our HIPAA EDI Day and the topic of the day is to simply provide you the list of how you can tell apart the 837 Institutional, from the 837 Professional, or from the 837 Dental.

837 Institutional, Professional, Dental

The 837 transaction has three different implementation guides specifically developed for Professional, Institutional and Dental claims. The specifications are geared to meet the individual requirements of the three different types of claim forms. For instance, the 837 Institutional manual allows for Value Codes, Occurrence Codes and Occurrence Spans. These fields are specific to the UB04 claim form only. The 837 Dental manual allows for Dental Coding and Tooth Designations. These are only used on dental claim forms. The SV segment occurs on each of the three 837 transactions but there is a slight variation for each claim. Professional uses an SV1 segment, Institutional uses an SV2 segment and Dental uses an SV3segment. This is a quick way to determine what type of 837 file is being encountered.

Structurally, all three sets of 837 specifications are same. The only differences would be claim specific data that pertains to a single transaction. All three transactions contain ISA, GS and ST segments but some data and qualifying codes are specific to the type of 837. Another way to quickly identify which type of 837 is being encountered is by the codes sent in the GS-08 or in the ST-03. Professionals use a 005010X222, Institutional uses a 005010X223 and Dental uses a 005010X224.
The most popular EDI claim type is the professional.


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