In the healthcare industry, X12 standards are mandated under HIPAA for the electronic exchange of healthcare-related transactions.
- 837 - Healthcare Claim: Used by healthcare providers to submit claims to payers (insurance companies) for services rendered.
- 837P: Professional claims.
- 837I: Institutional claims.
- 837D: Dental claims.
- 835 - Healthcare Payment/Advice: Provides an Explanation of Benefits (EOB) and payment details for claims.
- 270/271 - Eligibility Inquiry and Response: Used to inquire about a patient's health insurance coverage and benefits.
- 276/277 - Claim Status Inquiry and Response: Used to inquire about the status of a previously submitted healthcare claim.
- 834 - Benefit Enrollment and Maintenance: Used to enroll members in health insurance plans or update enrollment information.
- 820 - Payroll Deducted and Other Group Premium Payment: Communicates premium payment information to health insurance carriers.
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