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Medicare Billing: CMS-1500 & 837P

Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act (HIPAA) requires the Secretary of HHS to adopt standards for financial and administrative transactions, and data elements for those transactions.

These national standards make it easier for health plans, health care clearinghouses, physicians, hospitals, and other health care professionals and suppliers to process claims and other transactions electronically.

Use the X12 837 format to submit all HIPAA electronic claims. The Accredited Standards Committee (ASC) X12 develops and maintains the HIPAA EDI standards.

The American National Standards Institute (ANSI) ASC X12N 837P (837 Professional) Version 5010A1 claim format is the electronic format used to submit professional and supplier claims. To learn more, visit the ASC X12 website.