Basic information of a health insurance Claim

There  is a prescribed format to submit a claim. It is called EDI 837  which  is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information.

Providers can submit  claims directly to the payers. But they usually sent EDI 837 through intermediary billers or  clearinghouses. The basic information that a claim must contain is as follows:

Ø  Submitter's information (providers or intermediary billers or claims clearinghouses)

Ø  Receiver's information (insurance companies, health maintenance organizations (HMOs), preferred provider organizations (PPOs), or government agencies such as Medicare, Medicaid, etc.)

Ø   Provider's information

Ø   Subscriber's Information

Ø  Patient's information

Ø  The cost of the treatment including Coordination of benefits

Ø  The services provided

Ø  Date and place of services