The Basics of Understanding 837 Files: What You Need to Know
If you’re in the healthcare industry, you’ve likely heard of 837 files. But what exactly are they, and why are they so important? In this article, we’ll explore the basics of understanding 837 files and everything you need to know about them.
What Are 837 Files?
In simple terms, 837 files are electronic healthcare claims and payment files. They contain detailed information about healthcare services provided to patients, including the charges for those services. The files are sent from providers such as hospitals, clinics, and doctor’s offices to insurance companies for payment processing.
Why Are 837 Files Important?
Having accurate and timely 837 files is critical in ensuring that healthcare providers are reimbursed for the services they provide. Insurance companies use the files to process claims and provide payment to healthcare providers. Inaccurate or incomplete 837 files can result in delayed or denied payments, causing significant financial strain for healthcare providers.
The Two Types of 837 Files
There are two types of 837 files: professional and institutional. Professional 837 files are used for claims submitted by individual healthcare providers such as physicians and therapists. Institutional 837 files are used for claims submitted by hospitals and other large healthcare organizations.
Understanding the Structure of 837 Files
837 files have a specific structure that follows industry standards. The files are broken down into segments, each of which contains specific information about the healthcare services provided. The segments include:
– Header: This section contains general information about the file, including the sender and receiver.
– Provider: This segment contains information about the healthcare provider, including their name and address.
– Patient: This segment contains information about the patient, including their name, date of birth, and insurance information.
– Claim: This segment contains information about the healthcare services provided, including the CPT codes for each service.
– Payment: This segment contains information about the payment for the healthcare services provided.
Conclusion
Understanding 837 files is critical in ensuring accurate and timely payment for healthcare services provided. By familiarizing yourself with the structure and importance of 837 files, you can help ensure that your healthcare organization is reimbursed for the services it provides. Remember to always double-check the accuracy and completeness of your 837 files before submitting them to insurance companies to avoid any payment delays or denials.
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