4 Major Benefits of 837 Claims in Healthcare

If you’ve ever gone to the doctor’s office in the 90’s. You know exactly what I’m about to explain. Behind the front desk were endless shelves that were stuffed full of patient information and files. Back then, everything was still heavily focused on operating with paper. In other words, the entire healthcare claim submission process was achieved by filling out paper claim submission forms and sending them through the mail. Back then medical billing teams had to decipher hand written medical claims, talk about leaving the door wide open to mistakes. But, luckily, things have gotten a lot better today with 837 claims. The only question is…what the heck is that?
LINKS:
____________________________________________
etactics.com/b...
___________________________________________
An 837 refers to an electronic dataset containing information, primarily utilized by healthcare institutions for transmitting healthcare claims. Doesn't that definition sound quite broad? I mean, with such a general explanation, isn't it possible for a CSV document to qualify as an 837 file?
Where did 837 files come from?
Healthcare as a whole started heading towards 837 and 837 claims with the inception of the Health Insurance Portability and Accountability Act (HIPAA) in 1999.
Just one year after the inception of HIPAA, Congress started mentioning the need for electronic data interchange (EDI) in healthcare.
By 2003, 837 and 835 claim formats became the standardized and encrypted method to transmit healthcare claims and the sensitive information contained within them.
Why are 837’s so important?
837 claims are so important because they ensure timely and accurate remittance. In other words, practically every healthcare organization relies on them to receive revenue.
Are there any real benefits to using 837s?
The most significant distinction setting an 837 apart from other electronic file types lies in its adherence to HIPAA regulations. As I highlighted in the introduction of this video, paper-based claims were prevalent (and arguably still persist, depending on the insurance entity in question). If your healthcare organization's strategy focused on processing paper claims exclusively, you would opt for a CMS-1500 claim form.
But, other than the fact that they’re the required format for electronic claims, are there any benefits to 837s?
Of course, let’s go through them.
The first benefit is Precise Information Exchange: You can only imagine what kind of mistakes occurred in the paper claim submission process with paper CMS-1500 forms. Paper claims naturally open up the door to more mistakes through data entry and even misinterpreted handwriting. 837s have a standardized digital format which leads to more precision and accuracy. Naturally, that also means fewer claim rejections and denials.
Second, Mistake Detection: The standardized format of 837s also makes it easier to detect mistakes within the claim prior to submission to insurance. This is usually accomplished through your clearinghouse. However, it leads to fewer processing delays and a higher rate of remittance success.
Third, Improved Data Quality: The increase in data quality associated with the formalized format of 837s leads to improved data quality. Gone are the days of billing teams spending hours deciphering information on paper claims.
Fourth, Security: Since the government mandated the use of 837s in the healthcare space to align with HIPAA, they practically guarantee security. This leads to less leakage of sensitive patient information.
In essence, 837 claims stand are electronic files that serve as carriers of vital information within the healthcare industry, enabling seamless transmission of healthcare claims data. While their broad definition might raise questions about their specificity, the hallmark of an 837 lies in its adherence to HIPAA compliance. As the healthcare landscape continues to evolve, the 837 remains a cornerstone of efficient, secure, and standardized data exchange, bridging the gap between healthcare organizations and effective claims management and remittance.
► Reach out to Etactics @ www.etactics.com​
►Subscribe: rb.gy/pso1fq​ to learn more tips and tricks in healthcare, health IT, and cybersecurity.
►Find us on LinkedIn: / etactics-inc
►Find us on Facebook: / ​
#HealthcareClaims #ClaimManagement

[@ronaprescott4007]

I want to train my team on the tr3. Do you have a video or document that would explain this at a low & easy level?

[@eyecandie2004]

So do we need software to create an 837 claim?