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837 PROFESSIONAL CLAIMS AND ENCOUNTERS TRANSACTION COMPANION GUIDE JUNE 22, 2011, A S C × 1 2 N 8 3 7 (0 0 5 0 10 X 222A1) VERSION 1TABLE OF CONTENTS 1.0Background31.1Overview31.2Introduction42.0Data

How to fill out 837 professional claims and

How to fill out 837 professional claims and:

Gather patient information:

1. Obtain the patient's personal details, including name, address, and contact information.
2. Collect the patient's insurance information, such as policy number and group ID.
3. Make sure to have accurate demographic data, including date of birth and gender.

Collect billing information:

1. Gather information related to the healthcare services provided, such as medical procedures, diagnosis codes, and dates of service.
2. Include the appropriate Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes for each procedure.
3. Enter the number of units or quantity for each service rendered.

Verify insurance coverage:

1. Check the patient's insurance eligibility and coverage for the specific services rendered.
2. Determine if any pre-authorization or referral is required before submitting the claim.

Complete the claim form:

1. Use a reliable electronic health record (EHR) or practice management system to generate the 837 professional claim.
2. Ensure accurate data entry and review for any errors or missing information.
3. Include all relevant patient and billing details in the designated fields of the claim form.

Submit the claim:

1. Send the completed 837 professional claim electronically to the appropriate insurance payer.
2. Follow the submission guidelines provided by the payer, ensuring all required supporting documentation is included.
3. Verify that the claim has been successfully transmitted and received by the payer.

Who needs 837 professional claims and:

Healthcare providers:

1. Physicians, surgeons, and other healthcare professionals who offer medical services that are billable to insurance payers.
2. Hospitals, clinics, and healthcare facilities that provide inpatient or outpatient services.

Insurance companies:

Payers, including private health insurance companies, government programs (such as Medicare and Medicaid), and managed care organizations, require 837 professional claims to process and reimburse healthcare services.

Medical billing companies:

1. Organizations specializing in medical billing services may need to fill out 837 professional claims on behalf of healthcare providers.
2. These companies handle claim submissions, payment processing, denial management, and other aspects of medical billing.

For pdfFiller’s FAQs

What is 837 professional claims?

837 professional claims refer to the standard format used for submitting healthcare claims electronically.

Who is required to file 837 professional claims?

Healthcare providers, billing companies, and clearinghouses are required to file 837 professional claims.

How to fill out 837 professional claims?

837 professional claims can be filled out using billing software that supports the standard format set by HIPAA.

What is the purpose of 837 professional claims?

The purpose of 837 professional claims is to streamline the billing process and ensure accurate and timely payment for healthcare services.

What information must be reported on 837 professional claims?

837 professional claims must include patient information, service provided, diagnosis codes, and insurance information.

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