837 File Format Guide

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837 File Format Guide: A Critical Analysis of its Impact on Current Trends



Author: Dr. Anya Sharma, PhD in Healthcare Informatics, 15+ years experience in healthcare data management and HIPAA compliance.

Publisher: Health Data Insights, a leading publisher of healthcare IT resources with a 20-year track record and a strong reputation for accuracy and industry expertise.

Editor: Michael Davis, Certified Health Information Manager (CHIM), 10+ years experience in healthcare data processing and standards development.


Keywords: 837 file format guide, HIPAA, healthcare claims, electronic data interchange (EDI), healthcare data analytics, revenue cycle management, healthcare interoperability, data standardization, claims processing, 837P, 837I, 837D


Summary: This analysis delves into the crucial role of the 837 file format guide in today's healthcare landscape. We examine its impact on revenue cycle management, interoperability, and data analytics, highlighting both its strengths and limitations. The analysis considers the evolution of the 837 standard, the challenges faced by healthcare providers in its implementation, and future trends shaping its continued relevance.


1. Introduction: The Indispensable 837 File Format Guide



The 837 file format guide is a cornerstone of electronic healthcare transactions in the United States. As a standard under the HIPAA (Health Insurance Portability and Accountability Act) regulations, it dictates the structure and content of electronic healthcare claims submitted by healthcare providers to payers (insurance companies, Medicare, Medicaid). This comprehensive guide, often available from various sources, explains the complexities of the 837 standard, detailing the different transaction sets (837P, 837I, 837D) and their specific applications. Understanding this guide is vital for efficient claims processing and revenue cycle management within healthcare organizations. Without a thorough grasp of the 837 file format guide, healthcare providers risk significant financial losses due to rejected claims and delayed payments.


2. The Evolution of the 837 File Format and its Impact



The 837 standard has evolved over time to accommodate changes in healthcare technology and regulations. Early versions were simpler, but subsequent iterations introduced increased complexity to capture a wider range of healthcare services and billing scenarios. This evolution, while necessary to maintain accuracy and comprehensiveness, has also presented challenges for healthcare providers. Adapting to each update requires significant investment in software and staff training. The constant updates necessitate a continuously updated 837 file format guide to ensure accurate claim submission. The impact of these updates directly relates to the efficiency of the entire revenue cycle, impacting the bottom line of healthcare organizations.


3. Key Components of the 837 File Format Guide: Decoding the Complexity



A comprehensive 837 file format guide will typically cover several key areas:

Transaction Sets: The guide meticulously explains the differences between the three main transaction sets: 837P (professional claims), 837I (institutional claims), and 837D (dental claims). Each set has a unique structure and is designed for specific types of healthcare services.

Data Elements: The guide meticulously outlines each data element within the transaction sets, including their purpose, data types, and allowable values. This level of detail is critical for accurate claim submission. Errors in these data elements are a common reason for claim rejections.

Loop and Segment Structures: The 837 standard employs a hierarchical structure of loops and segments to organize the data. A thorough 837 file format guide will clearly illustrate these structures and their interrelationships. Understanding these structures is crucial for interpreting the data and identifying potential errors.

Coding Systems: The guide will provide a detailed explanation of the various coding systems used in 837 transactions, including CPT, HCPCS, ICD, and revenue codes. Accurate coding is essential for appropriate reimbursement.

Error Handling and Rejection Codes: A significant portion of a helpful 837 file format guide is dedicated to explaining common errors and their corresponding rejection codes. This information is crucial for identifying and correcting errors in claims submissions, minimizing rejections and streamlining the revenue cycle.


4. Challenges in Implementing the 837 File Format: Practical Considerations



Despite its importance, implementing the 837 file format presents several significant challenges:

Software Compatibility: Healthcare providers need compatible billing software that can accurately generate and transmit 837 files. The cost and complexity of implementing and maintaining this software can be substantial.

Data Integrity: Ensuring the accuracy and completeness of the data within the 837 file is paramount. Inaccurate data leads to claim rejections, delays in payments, and ultimately, financial losses.

Staff Training: Adequate training for staff responsible for generating and managing 837 files is essential. Without proper training, errors are more likely to occur.

Keeping Up with Changes: The ongoing evolution of the 837 standard necessitates constant updates to software and staff training. This requires significant ongoing investment and commitment.


5. The 837 File Format Guide and its Impact on Revenue Cycle Management



The 837 file format guide is directly linked to efficient revenue cycle management. Accurate and timely claim submissions, as facilitated by the guide, are critical for prompt reimbursement. A well-implemented 837 system minimizes claim rejections and reduces the time it takes to receive payments, leading to improved cash flow and financial stability for healthcare organizations. Conversely, deficiencies in understanding or implementation lead to significant financial losses.


6. The 837 File Format Guide and Healthcare Interoperability



The 837 standard plays a pivotal role in enhancing healthcare interoperability. By standardizing the format of healthcare claims, it facilitates seamless data exchange between healthcare providers and payers. This improved interoperability fosters greater efficiency, reduces administrative burden, and enhances the overall quality of healthcare. A clear and accessible 837 file format guide is therefore crucial for achieving optimal interoperability.


7. The 837 File Format Guide and Healthcare Data Analytics



Data from 837 files can be leveraged for valuable healthcare data analytics. By analyzing claim data, healthcare organizations can gain insights into patient demographics, treatment patterns, and reimbursement trends. This data-driven approach allows for better resource allocation, improved clinical decision-making, and enhanced operational efficiency. An understanding of the 837 file format guide is essential for effectively extracting and interpreting this valuable information.


8. Future Trends and the 837 File Format Guide



The future of the 837 file format is likely to involve continued evolution to accommodate advancements in healthcare technology and regulations. This includes the integration of new coding systems, the incorporation of telehealth claims, and the increased use of value-based care models. A constantly updated and comprehensive 837 file format guide will be indispensable in navigating these changes. The potential integration of AI and machine learning for automated error detection and correction based on 837 data is a significant future trend.


9. Conclusion



The 837 file format guide is an indispensable resource for healthcare providers seeking to streamline their revenue cycle, enhance interoperability, and leverage data analytics. While implementing the 837 standard presents challenges, the benefits of efficient claims processing and improved data management far outweigh the costs. A thorough understanding of the 837 file format guide, coupled with appropriate software and staff training, is essential for success in today's complex healthcare environment. The ongoing evolution of this standard underscores the need for continuous learning and adaptation within the healthcare industry.


FAQs



1. What are the three main 837 transaction sets? The three main transaction sets are 837P (professional claims), 837I (institutional claims), and 837D (dental claims).

2. What is the importance of accurate coding in 837 files? Accurate coding is crucial for ensuring accurate claim processing and appropriate reimbursement. Incorrect coding can lead to claim rejections or underpayment.

3. How can I find a reliable 837 file format guide? Reliable guides can be found through reputable healthcare IT publishers, professional organizations like AHIMA, and government resources like CMS.

4. What are the common reasons for 837 claim rejections? Common reasons include incorrect coding, missing data elements, and invalid data formats.

5. What software is needed to process 837 files? Various billing and claims management software solutions support 837 file processing. The choice depends on the size and needs of the healthcare organization.

6. How often is the 837 standard updated? The 837 standard is updated periodically to reflect changes in healthcare regulations and technology. Staying current with these updates is essential.

7. What is the role of HIPAA in the 837 standard? HIPAA mandates the use of electronic transactions, including 837 files, for healthcare claims.

8. How can I improve the accuracy of my 837 files? Implement robust data validation processes, provide thorough staff training, and utilize quality control measures.

9. What are the future implications of the 837 standard? Future implications include increased automation, integration with other healthcare systems, and further standardization to improve interoperability.


Related Articles:



1. "Understanding 837P Claims: A Comprehensive Guide": This article provides a deep dive into the specifics of the 837P transaction set for professional claims, covering its structure, data elements, and common challenges.

2. "Mastering 837I Institutional Claims: A Practical Approach": This article focuses on the nuances of 837I claims for institutional providers, providing practical advice and troubleshooting tips.

3. "Decoding 837D Dental Claims: A Guide for Dental Practices": This article specifically addresses the unique requirements of 837D claims for dental services.

4. "Top 10 Errors in 837 File Submissions and How to Avoid Them": This article highlights common errors in 837 file submissions and provides practical strategies for avoiding them.

5. "837 File Validation: Ensuring Accurate Claims Processing": This article discusses various methods for validating 837 files to ensure accuracy and minimize rejections.

6. "The Impact of 837 on Healthcare Revenue Cycle Management": This article explores the significant role of the 837 standard in streamlining the revenue cycle and improving financial performance.

7. "Improving Healthcare Interoperability through Standardized 837 Files": This article focuses on the contribution of the 837 standard to improving data exchange and interoperability in the healthcare industry.

8. "Leveraging 837 Data for Enhanced Healthcare Data Analytics": This article explores how data extracted from 837 files can be used to generate valuable insights for better decision-making.

9. "Future Trends in Healthcare Claims Processing: The Evolution of the 837 Standard": This article discusses the likely future developments in the 837 standard and their implications for healthcare providers.


  837 file format guide: Document Drafting Handbook Gladys Q. Ramey, Barbara Suhre, Ernie Sowada, 1991
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  837 file format guide: Step-By-Step Medical Coding, 2017 Edition Carol J. Buck, 2016-12-06 Resource ordered for the Health Information Technology program 105301.
  837 file format guide: (ISC)2 CISSP Certified Information Systems Security Professional Official Study Guide Mike Chapple, James Michael Stewart, Darril Gibson, 2018-04-11 NOTE: The CISSP objectives this book covered were issued in 2018. For coverage of the most recent CISSP objectives effective in April 2021, please look for the latest edition of this guide: (ISC)2 CISSP Certified Information Systems Security Professional Official Study Guide, 9th Edition (ISBN: 9781119786238). CISSP (ISC)2 Certified Information Systems Security Professional Official Study Guide, 8th Edition has been completely updated for the latest 2018 CISSP Body of Knowledge. This bestselling Sybex study guide covers 100% of all exam objectives. You'll prepare for the exam smarter and faster with Sybex thanks to expert content, real-world examples, advice on passing each section of the exam, access to the Sybex online interactive learning environment, and much more. Reinforce what you've learned with key topic exam essentials and chapter review questions. Along with the book, you also get access to Sybex's superior online interactive learning environment that includes: Six unique 150 question practice exams to help you identify where you need to study more. Get more than 90 percent of the answers correct, and you're ready to take the certification exam. More than 700 Electronic Flashcards to reinforce your learning and give you last-minute test prep before the exam A searchable glossary in PDF to give you instant access to the key terms you need to know for the exam Coverage of all of the exam topics in the book means you'll be ready for: Security and Risk Management Asset Security Security Engineering Communication and Network Security Identity and Access Management Security Assessment and Testing Security Operations Software Development Security
  837 file format guide: Microsoft Office 2003 All-in-one Joseph W. Habraken, 2004 Presents a guide to the applications found in Microsoft Office, including Excel, Access, Word, PowerPoint, and Outlook.
  837 file format guide: HIPAA Certification Training Official Guide: CHPSE, CHSE, CHPE Supremus Group LLC, 2014-05-26
  837 file format guide: Section 1557 of the Affordable Care Act American Dental Association, 2017-05-24 Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.
  837 file format guide: Hierarchical File System Usage Guide Nigel Morton, 2000
  837 file format guide: A Practical Guide to Red Hat Linux 8 Mark G. Sobell, 2003 Based on his successful A Practical Guide to Linux, Sobell is known for his clear, concise, and highly organized writing style. This new book combines the strengths of a tutorial and those of a reference to give readers the knowledge and skills to master Red Hat Linux.
  837 file format guide: Cisco CCNA Data Center DCICT 640-916 Official Certification Guide Navaid Shamsee, David Klebanov, Hesham Fayed, Ahmed Afrose, Ozden Karakok, 2015 This is Cisco's official, comprehensive self-study resource for preparing for the new CCNA Data Center DCICT 640-916 certification exam. Designed for all data center administrators and professionals seeking Cisco DCICT certification, it covers every exam objective concisely and logically, with extensive teaching features designed to promote retention and understanding. Readers will find clear and practical coverage of Cisco's entire exam blueprint.
  837 file format guide: Complete CompTIA A+ Guide to IT Hardware and Software Cheryl A. Schmidt, 2016-06-09 Master IT hardware and software installation, configuration, repair, maintenance, and troubleshooting and fully prepare for the CompTIA® A+ 220-901 and 220-902 exams. This all-in-one textbook and lab manual is a real-world guide to learning how to connect, manage, and troubleshoot multiple devices in authentic IT scenarios. Thorough instruction built on the CompTIA A+ 220-901 and 220-902 exam objectives includes coverage of Linux, Mac, mobile, cloud, and expanded troubleshooting and security. For realistic industry experience, the author also includes common legacy technologies still in the field along with non-certification topics like Windows 10 to make this textbook THE textbook to use for learning about today’s tools and technologies. In addition, dual emphasis on both tech and soft skills ensures you learn all you need to become a qualified, professional, and customer-friendly technician. Dozens of activities to help “flip” the classroom plus hundreds of labs included within the book provide an economical bonus–no need for a separate lab manual. Learn more quickly and thoroughly with all these study and review tools: Learning Objectives provide the goals for each chapter plus chapter opening lists of A+ Cert Exam Objectives ensure full coverage of these topics Hundreds of photos, figures, and tables to help summarize and present information in a visual manner in an all-new full color design Practical Tech Tips give real-world IT Tech Support knowledge Soft Skills best practice advice and team-building activities in each chapter cover all the tools and skills you need to become a professional, customer-friendly technician in every category Review Questions, including true/false, multiple choice, matching, fill-in-the-blank, and open-ended questions, assess your knowledge of the learning objectives Hundreds of thought-provoking activities to apply and reinforce the chapter content and “flip” the classroom if you want More than 140 Labs allow you to link theory to practical experience Key Terms identify exam words and phrases associated with each topic Detailed Glossary clearly defines every key term Dozens of Critical Thinking Activities take you beyond the facts to complete comprehension of topics Chapter Summary provides a recap of key concepts for studying Certification Exam Tips provide insight into the certification exam and preparation process
  837 file format guide: Federal Register , 1998-05-06
Companion Guide - Cigna Healthcare
This Companion Guide has been designed to describe to Cigna's trading partners the format and data content of the 837 Professional Health Care Claim transaction in the Electronic Data …

837 Professional Claim/Encounter Standard Companion …
This companion guide was developed for use in conjunction with the ASC X12N 837 Professional (005010X222A1) Technical Reports Type 3. For any submission to MD On-Line, Inc. (MDOL) if …

HIPAA Transaction Standard Companion Guide
Tufts Health Plan – HIPAA Transaction Standard Companion Guide 1 Rev. 09/2024 . HIPAA Transaction Standard Companion Guide . Refers to the Implementation Guides Based on ASC …

EDI 837P COMPANION GUIDE - hcdpbc.org
claims submission. The guide contains information on who to contact, clearinghouses, and EDI requirements by the District and Healthy Palm Beaches. The Health Care District and Healthy …

Medicare Billing: CMS-1450 & 837I
Each MAC publishes a CMS-approved companion guide to supplement the implementation guide that offers further Medicare instructions. The 5010A2 - Part A 837 Companion Guide (CG) …

TMHP Document Template
Companion Guide for the 837 file format. All instructions in this document are written using information known at the time of publication and are subject to change. 1.2 Overview This …

Care Management Import 837 User Guide - swmbh.org
In the cases in which file format validation fails, there will be no ‘Parsing Errors’ and no ‘atches’ displayed. Additionally, the 997 file text will indicate that the 837 file was rejected. Parsing …

Standard Companion Guide Health Care Claim: Institutional …
Accountability Act of 1996 (HIPAA) as well as additional supporting transactions as described in this guide. Medicare Fee-For-Service (FFS) is publishing this Companion Guide (CG) to clarify, …

Streamline 837 Companion Guide - iskzoo.org
Oct 30, 2015 · ProviderAccess utilizes 3 levels of validation when processing 837 files 1. File Format Errors 2. Parsing Errors 3. Processing Errors File Format Errors Upon submitting an …

837D ACUTE CARE COMPANION GUIDE 5010 - tmhp.com
Guide for the 837 file format. All instructions in this document are written using information known at the time of publication and are subject to change. Overview This guide is intended as a …

837 Professional Encounter Claims - Cloudinary
Sep 10, 2020 · segments. A separate file for each transaction type should be submitted – for example, one file containing only the 837P professional data, one file containing only 837I …

837 Institutional Claims Standard Companion Guide - Providers
837 Institutional Claims Standard Companion Guide January 2025 Overview The 837I inbound is the claim transaction sent from the trading partner to Louisiana Blue to request claim …

Instructions Related to 837 Health Care Claim: Institutional …
X12 Implementation Guide. ... All alpha characters used in 837 transactions must be in an uppercase format. The 837 transaction must not contain any carriage returns nor line feeds; …

Companion Guide - Cigna Healthcare
This Companion Guide has been designed to describe to Cigna's trading partners the format and data content of the 837 Institutional Health Care Claim transaction in the Electronic Data …

Companion Guide: 837 Professional Claims and Encounters …
In addition to compliance checking and the resulting 997 Acknowledgement file, the IHCP creates a Biller Summary Report (BSR) in response to all 837 submissions. This report provides …

Companion Guide: 837P (Health Care Claim: Professional)
Sep 17, 2015 · Harmony 837P Companion Guide, AL Edition Page 5 of 14 2/11/2019 Confidential No unauthorized copying or distribution permitted 5010 Change Loop ID Segment ID Data …

Claims Acceptable Through the 837 Formats
‹‹ASC X12N 837 v.5010 claims are processed through the same claim verification programs as paper claims. The 837 claims and paper claims must meet the same edit and audit …

Microsoft Word - 837 Companion Guide - DOL
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837 Health Care Claim Professional - TRICARE West
Oct 1, 2017 · Standard Companion Guide . ASC X12N 837 (005010X222A1) Health Care Claim Professional . Version 1.0 . October 2017 . PGBA 837P 5010 Companion Guide . Page 2 of 19. …

Standard Companion Guide - UHCprovider.com
Mar 10, 2025 · The companion guide is not intended to convey information that in any way exceeds the requirements or usages of data expressed in the Implementation Guide. The …

CMS 837I NOA Companion Guide - Centers for Medicare
CMS 837I NOA Companion Guide . 1 . CMS . Companion Guide Transaction Information . Instructions related to the Non-Standard Use of the 837 Health Care Claim: Institutional …

837D Dental Implementation Guide - MVP Health Care
Dental Implementation Guide for ANSI X12 837 – Version 005010X222A1 3 VERSION CHANGE LOG . ... (Secure File Transfer Protocol) with PGP encryption. Dental Implementation Guide for …

Critical Error Report Guide for 837 Files - LA County …
files within a one service to one claim format, these two reports will have a 1:1 cl aim to service ratio. ... 837 file submitted to SAPC via SFTP . 2. File is automatically processed . ...

835 Flat File - 5010A1 - Centers for Medicare & Medicaid …
Jan 10, 2023 · BPR05 Payment Format Code PIC X(10) ID 1--10 BPR04 Payment Method Code PIC X(3) ID 3--3 ACH,CHK,NON C: 39; 1 21 18 BPR03: ... X12 Element Attributes----- X12 Flat …

837 Transaction Companion Guide - CDPHP
identify a file as unique for that Trading Partner on a given day. We ask Trading Partners to be aware if submitting more than one file per day, you MUST use a unique sequence number for …

837 Companion Guide - Home State Health
837 Companion Guide ... Use Military format, or numbers from 0 to 23, to indicate hours. For example, an admission date of 201006262115 defines the date and time of June 26, 2010 at …

837 Encounter Companion Guide
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Companion Guide 837 – Institutional Health Care Claim Based …
5.1 837 Institutional Health Care Claim - Header 5.1.1 837 Institutional Health Care Claim - Submitter/Receiver Details 5.2 837 Institutional Health Care Claim - Detail 5.2.1 837 Detail: …

837D Health Care Claim: Dental
Companion Guide for the 837 file format. All instructions in this document are written using information known at the time of publication and are subject to change. Overview This guide is …

837D Health Care Claim Companion Guide - ctdssmap.com
the implementation guide. • Modifying any requirement contained in the implementation guide. 1.2 Intended Use The Transaction Instruction component of this companion guide must be used in …

837D ACUTE CARE COMPANION GUIDE 5010 - TMHP
Guide for the 837 file format. All instructions in this document are written using information known at the time of publication and are subject to change. Overview This guide is intended as a …

837P Health Care Claim Companion Guide - ctdssmap.com
837P Health Care Claim Companion Guide March 2011 005010 7 3.1 837 Health Care Claim: Professional The 837 Professional Transaction is used to submit health care claims and …

HIPAA 837 Companion Guide V1.6- 11.21.17 - LA County …
Jul 23, 2019 · GUIDE . HIPAA 837P . Health Insurance Portability and Accountability Act Industry-wide standards for health care electronic billing, data ... 837 file, as claims on Member …

837 STANDARD COMPANION GUIDE TRANSACTION …
837 STANDARD COMPANION GUIDE . TRANSACTION INFORMATION . CLAIMS: PROFESSIONAL, INSTITUTIONAL AND DENTAL ... ISA INTERCHANGE CONTROL …

837I Health Care Claim Companion Guide - ctdssmap.com
The 837 Institutional Transaction is used to submit health care claims and encounter data to a payer for payment. This format is used to bill long term care, inpatient, outpatient, and home …

Standard Companion Guide - NGS Medicare
Standard Companion Guide Health Care Claim Institutional (837I) Based on ASC X12N TR3, Version 005010X223A2 Companion Guide Version Number: 7.0 ... This CG provides technical …

Standard Companion Guide Health Care Claim: Professional …
Accountability Act of 1996 (HIPAA) as well as additional supporting transactions as described in this guide. Medicare Fee-For-Service (FFS) is publishing this Companion Guide (CG) to clarify, …

Standard Companion Guide - FCSO
Centers for Medicare & Medicaid Services (CMS) Standard Companion Guide Health Care Claim: Professional (837P) Based on ASC X12N TR3, Version 005010X222A1

OA COMPANION GUIDE - Office Ally
Office Ally | P.O. Box 872020 | Vancouver, WA 98687 www.officeally.com Phone: 360-975-7000 Fax: 360-896-2151 INTRODUCTION DISCLOSURE STATEMENT

Standard Companion Guide Transaction Information
username and password. PHC grants users access to both file transfer methods and users may switch back and forth between methods as desired. Both file transfer options access the same …

TEXAS MEDICAID
The 5010 Technical Report Type 3 (TR3) dated May 2006 was used to create this Companion Guide for the 837 file format. All instructions in this document are written using information …

Standard Companion Guide: Health Care Claim Payment / …
Centers for Medicare & Medicaid Services (CMS) Standard Companion Guide Health Care Claim Payment / Advice (835) Based on ASC X12N TR3, Version 005010X221A1

Companion Guide: 837 Professional Claims and Encounters …
In addition to compliance checking and the resulting 997 Acknowledgement file, the IHCP creates a Biller Summary Report (BSR) in response to all 837 submissions. This report provides …

Medicaid Enterprise System (MES) MMIS Companion Guide …
Format for EVV Time Data (Page 11) Version 1.9 Modified SV101-7 Description Comments to reflect HHMM 05/20/2019 Format for EVV Time Data (Page 11). The Colon was removed from …

837 File Format Guide (Download Only) - x-plane.com
837 File Format Guide: A Critical Analysis of its Impact on Current Trends Author: Dr. Anya Sharma, PhD in Healthcare Informatics, 15+ years experience in healthcare data management …

Quick Reference Guide - Working With the 835 Remittance …
Oct 20, 2003 · a. Once you have successfully received your file, look to see where your file was downloaded. b. If you are lucky and the network does not go down, file will be located in R: …

Care Management Import 837 User Guide - Southwest …
In the cases in which file format validation fails, there will be no ‘Parsing Errors’ and no ‘atches’ displayed. Additionally, the 997 file text will indicate that the 837 file was rejected. Parsing …

Streamline 837 Companion Guide - Southwest Michigan …
Smartcare utilizes 3 levels of validation when processing 837 files . 1. File Format Errors 2. Parsing Errors 3. Processing Errors File Format Errors Upon submitting an 837 file for …

837 Professional Companion Guide, September 2014
The CMS EDS 837-P Companion Guide includes information required to initiate and maintain communication exchange with CMS. The information is organized in the sections listed below: …

TMHP Document Template
Companion Guide for the 837 file format. All instructions in this document are written using information known at the time of publication and are subject to change. 1.2 Overview This …