Patient data from a physician’s office practice management software is used to populate ______the the computer to the third-party clearinghouse or the payer. claim and the claim is electronically transmitted from
837P
UB-04
CMS-1500
CMS-1450
The correct answer and explanation is:
The correct answer is 837P.
The 837P is the standardized electronic format used to submit claims from healthcare providers to third-party payers, such as insurance companies, for reimbursement. This format is part of the HIPAA (Health Insurance Portability and Accountability Act) standards for electronic transactions. The 837P form is used specifically for professional healthcare claims, which typically involve services provided by physicians, individual practitioners, and other non-institutional providers.
The 837P claim format includes essential data about the patient, healthcare provider, services provided, and the diagnosis, and is transmitted electronically to insurance companies or clearinghouses. This format replaces the paper-based CMS-1500 form, which was traditionally used for these types of claims. With the 837P, healthcare providers can streamline the billing process, improve accuracy, and reduce administrative costs. It allows for faster claim processing, quicker reimbursements, and a reduction in errors compared to paper submissions.
The other options listed are also related to healthcare claims but serve different purposes:
- UB-04: This form is used for institutional claims, such as those submitted by hospitals or other facility-based providers.
- CMS-1500: This paper claim form was historically used for professional claims, but it has been largely replaced by the electronic 837P format.
- CMS-1450: This is another term for the UB-04 form used for institutional claims.
In summary, the 837P electronic claim format is designed for professional services and facilitates efficient, accurate, and timely claim submission to third-party payers.