What is an EDI 837-Q3 Health Care Claim: Institutional?

What is an EDI 837-Q3 document used for? One of the X12 transactions, EDI 837-Q3 document is used to submit healthcare claim billing details, encounter information, or both. The EDI 837-Q3 transaction set can be exchanged between payers, or payers and regulatory agencies. The payer is a third-party entity that is responsible for paying the claim or administering the insurance product. Similarly, the regulatory agency is responsible for managing and monitoring a statutory benefits program.

EDI X12 837-Q3 Health Care Claim: Institutional Sample

The following EDI 837-Q3 sample file demonstrates the different data elements and segments that are found within an EDI 837-Q3 transaction document[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-Q3 Health Care Claim: Institutional

The EDI 837 Institutional Health Care Claim is one of the most commonly used healthcare transactions. Using the EDI 837-Q3 transaction set allows healthcare service providers to remain in compliance with HIPAA standards by ensuring accurate and secure claim processing.

Achieve EDICompliance with Astera EDIConnect

Astera EDIConnect streamlines the process of sending and receiving EDI messages by providing support for EDI X12 and EDIFACT transaction sets. With a built-in EDI parser, validator, and transaction builder, AsteraEDIConnect enables seamless communication between trade partners.

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