Get the free 837 Professional - Health Care Authority - hca wa

State of Washington 837 Professional Healthcare Claim Companion Guide Prepared by: ANSI August 2012 WAMMIS-CG-837P-CLAIMS-5010-01-01 Disclaimer This companion guide contains data clarifications derived

How to fill out 837 professional - health

How to fill out 837 professional - health:

1. Gather all necessary information: Before starting the process, ensure you have all the relevant patient information, such as their name, date of birth, insurance details, and medical record number.
2. Identify the provider information: Include the details of the medical practice or provider submitting the claim, such as their name, National Provider Identifier (NPI) number, and contact information.
3. Select the appropriate form version: Make sure to use the correct edition/version of the 837 professional - health form as specified by the industry standards.
4. Complete the header section: Fill out the top portion of the form, including the patient control number, transaction control number, and the date of the claim.
5. Include patient details: Input the patient's personal information, such as their name, date of birth, gender, and contact details. Also, provide the patient's relationship to the insured party, if applicable.
6. Fill in the diagnosis codes: Enter the appropriate International Classification of Diseases (ICD) diagnosis codes that correspond to the medical services being claimed. These codes help identify the medical necessity of the treatments.
7. Specify the services provided: Indicate the healthcare services rendered to the patient by entering the associated Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes. Add modifiers as necessary to provide additional information or clarify the billing.
8. Include provider information: Enter the NPI number and name of the healthcare provider who performed the services. Additional information, such as the practice address, tax identification number, and rendering provider information, may also be required.
9. Provide claim information: Input the details regarding the claim, such as the date of service, the place where the services were provided, and the charges associated with each service.
10. Review and submit the form: Carefully review all the information filled in the 837 professional - health form to ensure accuracy and completeness. Once satisfied, submit the form electronically or in the specified format required by the insurance company or payer.

Who needs 837 professional - health?

1. Healthcare providers: Medical practices, hospitals, clinics, and other healthcare providers who offer professional medical services need to fill out the 837 professional - health form. This form is necessary for submitting claims electronically to insurance companies or government payers for reimbursement.
2. Medical billers and coders: Professionals involved in medical billing and coding, including certified coders and billing specialists, require a thorough understanding of how to accurately complete the 837 professional - health form. They play a crucial role in translating medical documentation into the appropriate codes and ensuring proper reimbursement.
3. Insurance companies and payers: These entities receive and process the 837 professional - health forms submitted by healthcare providers. Understanding the structure of the form and the information required helps insurance companies efficiently process and adjudicate claims, determining the reimbursement amounts for the provided services.
4. Health information technology professionals: Professionals working in the field of health information technology, such as EHR (Electronic Health Record) system developers or healthcare software vendors, need to understand the 837 professional - health form structure to develop systems that can generate and process these claims accurately and compliantly.

For pdfFiller’s FAQs

What is 837 professional - health?

837 professional - health is a standard electronic format used for submitting healthcare claims to payers, such as insurance companies or government health programs.

Who is required to file 837 professional - health?

Healthcare providers, such as physicians, hospitals, and other healthcare facilities, are required to file 837 professional - health when submitting claims for reimbursement.

How to fill out 837 professional - health?

837 professional - health forms can be filled out using practice management software or clearinghouses that are compliant with the HIPAA transactions and code sets requirements.

What is the purpose of 837 professional - health?

The purpose of 837 professional - health is to streamline the claims submission process and standardize the format of healthcare claims for faster processing and fewer errors.

What information must be reported on 837 professional - health?

837 professional - health must include patient demographics, diagnosis codes, procedure codes, provider information, and billing details.

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