What is an EDI 837-Q2 Health Care Claim: Dental?

One of the X12 transactions, EDI 837-Q2 is used to convey healthcare claim billing details, encounter information, or both. This transaction set is commonly used for health data exchange between payers, or a payer and regulatory agency.

EDI X12 837-Q2 Health Care Claim: Dental Sample

An EDI 837-Q2 document is divided into functional groups that explain the contents of the transaction being conducted. A sample EDI 837-Q2 document looks like this[1].

ISA*00* *00* *01*9012345720000 *01*9088877320000
*100816*1144*U*00200*000000031*0*T*:~
GS*HC*901234572000*908887732000*20100816*1615*31*X*005010X223A1~
ST*837*0034*005010X223A1~
BHT*0019*00*3920394930203*20100816*1615*CH~
NM1*41*2*HOWDEE HOSPITAL*****46*0123456789~
PER*IC*BETTY RUBBLE*TE*9195551111~
NM1*40*2*BCBSNC*****46*987654321~
HL*1**20*1~
NM1*85*2*HOWDEE HOSPITAL*****XX*1245011012~
N3*123 HOWDEE BLVD~
N4*DURHAM*NC*27701~
REF*EI*123456789~
PER*IC*WILMA RUBBLE*TE*9195551111*FX*6145551212~
HL*2*1*22*0~
SBR*P*18*XYZ1234567******BL~
NM1*IL*1*DOUGH*MARY****MI*24672148306~
N3*BOX 12312~
N4*DURHAM*NC*27715~
DMG*D8*19670807*F~
NM1*PR*2*BCBSNC*****PI*987654321~
CLM*2235057*200***13:A:1***A**Y*Y~
DTP*434*RD8*20100730-20100730~
CL1*1*9*01~
REF*F8*ASD0000123~
HI*BK:25000~
HI*BF:78901~
HI*BR:4491:D8:20100730~
HI*BH:41:D8:20100501*BH:27:D8:20100715*BH:33:D8:20100415*BH:C2:D8:20100410~
HI*BE:30:::20~
HI*BG:01~
NM1*71*1*SMITH*ELIZABETH*AL***34*243898989~
REF*1G*P97777~
LX*1~
SV2*0300*HC:81000*120*UN*1~
DTP*472*D8*20100730~
LX*2~
SV2*0320*HC:76092*50*UN*1~
DTP*472*D8*20100730~
LX*3~
SV2*0270*HC:J1120*30*UN*1~
DTP*472*D8*20100730~
SE*38*0034~
GE*1*30~
IEA*1*000000031~

Workflow for the Exchange of an EDI 837-Q2 Health Care Claim: Dental

The EDI 837-Q2 transaction set is one of the widely used healthcare transaction sets, which aids the transmission of claim information. The information exchanged includes healthcare provider details, patient insurance plan, services provided, and patient’s medical history.

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Featuring a built-in EDI parser, validator, and transaction builder, Astera EDIConnect streamlines the process of sending and receiving EDI messages. Moreover, Astera EDIConnect provides support for EDI X12 and EDIFACT transaction sets, enabling seamless communication between trade partners.

[1] https://www.bluecrossnc.com/sites/default/files/document/attachment/providers/public/pdfs/837_Institutional_5010_v3.4.pdf