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Spotlight PEPPOL BIS Billing 3.0 The EU e-invoicing mandate is here — France Sept 2026, Belgium Jan 2026, Germany 2025.

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Foundations

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Standards

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Flagship messages

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Tools

X12 837 — Health Care Claim

The claim: reimbursement request sent by a provider (physician, hospital, dentist) to a payer, with three HIPAA implementation guides tied to the care context.

Purpose

The 837 describes the care event: who (rendering provider, supervising physician, referring), for whom (subscriber, patient), for what (ICD-10 diagnosis, CPT/HCPCS procedure), when (service date, units), where (place of service), and how much (charged amount, contractual reference). Three TR3s segment the audience:

  • 837P (Professional) — office visit, telemedicine, ambulatory care.
  • 837I (Institutional) — inpatient, ED, facility-based care, hospice.
  • 837D (Dental) — dental services.

Envelope and structure

The 837 uses the standard triple X12 envelope with GS01 = HC. The TR3 in ST03 distinguishes P/I/D. Minimal 837P example (one member, two services):

x12 minimal-837P.x12 
ISA*00*          *00*          *ZZ*PROVIDER01     *ZZ*PAYER99        *260415*1030*U*00501*000000837*0*P*>~
GS*HC*PROVIDER01*PAYER99*20260415*1030*1*X*005010X222A1~
ST*837*0001*005010X222A1~
BHT*0019*00*REQ-CLM-001*20260415*1030*CH~
NM1*41*2*ACME CLINIC*****46*1234567890~
PER*IC*BILLING DEPT*TE*5551234567~
NM1*40*2*PAYER99*****46*PAYER99~
HL*1**20*1~
NM1*85*2*ACME CLINIC*****XX*1234567890~
N3*100 MAIN ST~
N4*ATLANTA*GA*30303~
REF*EI*987654321~
HL*2*1*22*0~
SBR*P*18*GRP4567*****CI~
NM1*IL*1*DOE*JANE****MI*MEMBER12345~
N3*250 OAK AVE~
N4*ATLANTA*GA*30309~
DMG*D8*19850412*F~
NM1*PR*2*PAYER99*****PI*PAYER99~
CLM*PATACCT-9911*620.00***11:B:1*Y*A*Y*Y~
HI*ABK:M5435~
LX*1~
SV1*HC:99213*120.00*UN*1***1~
DTP*472*D8*20260401~
LX*2~
SV1*HC:90834*500.00*UN*1***1~
DTP*472*D8*20260401~
SE*26*0001~
GE*1*1~
IEA*1*000000837~

Common segments (concept)

  • Header — BHT Beginning of Hierarchical Transaction (with purpose 00 Original, transaction type CH Chargeable / RP Reporting), submitter NM1*41, receiver NM1*40.
  • Detail — three hierarchical levels: 2000A Billing Provider (practice or facility, with NPI, taxonomy, TIN), 2000B Subscriber Loop (contract holder, SBR Subscriber Information with relationship code, claim filing indicator CI Commercial Insurance, MB Medicare Part B, MC Medicaid, etc.), 2000C Patient Loop (the patient when different from the subscriber). At the claim level, CLM Claim Information carries the patient account, total charge, facility code, claim frequency. HI Health Care Information Codes carries ICD-10 diagnoses (qualifier ABK Principal Diagnosis, ABF Other Diagnosis). The service section groups LX + SV1 (Professional) / SV2 (Institutional) / SV3 (Dental) detailing each procedure with its CPT / HCPCS / CDT code, modifiers, units, charge, and service date via DTP.
  • Summary — a single SE.

When you'll see it

The 837 is the highest-volume transaction in US healthcare EDI: every commercial and public payer (Medicare, Medicaid, Tricare) consumes hundreds of millions per month. The entire provider-side billing revolves around its generation: from the EHR (Epic, Cerner, Athenahealth, NextGen) or the PMS (Kareo, AdvancedMD, eClinicalWorks), through a clearinghouse (Availity, Change Healthcare, Waystar, Trizetto), with 277CA, 999, and ultimately 835 returns.

Documentation