EDI Resource Center

X12 EDI 837

What is an EDI 837 Healthcare Claim?

The EDI 837 Healthcare Claim transaction set is used to submit healthcare medical claims, encounter information, billing information or both, from healthcare services providers to payers. This can be done directly or via intermediary billers and claims clearinghouses.

How is an EDI 837 Used?

The EDI 837 Healthcare Claim involves the submission of healthcare claim billing information, encounter information, or both. This X12 Transaction Set has the format and builds the data contents of the Healthcare Claim Transaction Set (837) for use within the context of an EDI environment.

EDI 837 Benefits

  • Allows healthcare providers to connect with insurers and smooth out backend operations
  • Improved efficiency and accuracy of healthcare billing for both providers & insurers
  • Faster reimbursement for providing healthcare

Key Data Elements You'll Find in a Healthcare Claim:

  • Patient description
  • The patient's condition (why treatment was provided)
  • Provided services
  • Treatment cost

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