Executive summary. A professional claim moves through preparation, validation, submission, acknowledgement, adjudication, and remittance, and each stage answers a different question.
Definition
The 837P is the HIPAA standard electronic transaction for professional healthcare claims.
Keep the transaction states apart
A claim can be drafted, validated, submitted, accepted by a clearinghouse, accepted by a payer, adjudicated, and paid. Each state answers a different operational question, and one status field answers none of them well.
A transport acknowledgement establishes delivery. Store its control number and the payload it refers to, then wait for the payer’s adjudication and remittance before recording anything about money.
Correction requires lineage
When correcting a claim, keep the relationship to the original and the reason for the replacement or void. A fresh submission with no lineage invites duplicate payment, duplicate denial, or both.
Validate before transmission, and report errors a person can act on without writing protected data into logs.
Frequently asked questions
Is an 837P the same as an invoice?
No. It is a standardized healthcare claim transaction, and payers publish their own implementation requirements on top of the standard.
Referenced standards and further reading
- CMS: HIPAA administrative simplification ↗Centers for Medicare & Medicaid Services
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