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Understanding 837 and 835 Healthcare Standards: An Overview of Eligibility and Claim Status

This guide provides an overview of the healthcare transaction standards including the 837 Institutional, Professional, and Dental formats, as well as the 835 Remittance Advice. We discuss important processes like eligibility verification (270/271), referral and authorization (278), and claim status inquiries (276/277). Additionally, we explore Coordination of Benefits (COB) ensuring that healthcare claims are processed accurately and efficiently. This resource is essential for healthcare professionals aiming to navigate these critical systems effectively.

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Understanding 837 and 835 Healthcare Standards: An Overview of Eligibility and Claim Status

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Presentation Transcript

  1. 5010 vs. 4010A1 standards

  2. 837 Institutional

  3. 837 Institutional

  4. 837 Professional

  5. 837 Dental

  6. 835- Remittance Advice

  7. 270/271 -Eligibility

  8. 278- Referrals &Authorization

  9. Health Care Claim Status (276/277)

  10. Health Care Claim Status (276/277)

  11. 837 - COB

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