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An 837 EDI file is an electronic format used to submit healthcare claims to insurance payers, following HIPAA standards. It replaces traditional paper claims, ensuring faster, more accurate processing. The 837 format is commonly used for medical billing, including workers’ compensation and auto no-fault claims, to streamline reimbursement from insurance carriers.

How Simpliclaim Supports 837 EDI Files for Workers’ Compensation & Auto No-Fault Billing

At Simpliclaim, we simplify the electronic submission of 837 EDI files for workers’ compensation and auto no-fault claims by:

✅ Seamless EDI Integration – Our system processes 837P (Professional) and 837I (Institutional) claims efficiently.

✅ Error Prevention – Built-in validation tools reduce claim rejections by ensuring compliance with payer requirements.

✅ Automated Submission & Tracking – Send and monitor claims in real time to accelerate reimbursements.

✅ Secure & Compliant Processing – We follow industry standards to keep your data safe and meet HIPAA regulations.

With Simpliclaim, providers and billing teams can submit workers’ compensation and auto no-fault claims effortlessly, reducing paperwork, minimizing errors, and ensuring faster payments.

ISA*00* *00* *ZZ*SENDERID *ZZ*RECEIVERID *230401*1200*^*00501*000000123*1*T*:~

GS*HC*SENDERID*RECEIVERID*20230401*1200*123456*X*005010X222A1~

ST*837*0001*005010X222A1~

BHT*0019*00*0123456789*20230401*1200*CH~

NM1*41*2*Billing Provider Name*****46*123456789~ PER*IC*Billing Contact*TE*5555555555~ NM1*40*2*Insurance Payer*****46*987654321~ HL*1**20*1~ NM1*85*2*Provider Clinic*****XX*1234567893~

N3*123 Main Street~

N4*City*ST*12345~

REF*EI*987654321~

HL*2*1*22*1~

SBR*P*18*GroupNumber*****AM~

NM1*IL*1*Doe*John****MI*JD123456789~

N3*456 Elm Street~

N4*City*ST*67890~

DMG*D8*19800101*M~

REF*SY*111551234~

REF*Y4*CLAIM#123456~

NM1*PR*2*NYC LAW DEPARTMENT*****PI*NEWYO132~

CLM*1234567890*150***11:B:1*Y*A*Y*Y*AA::::NY~

DTP*431*D8*20100402~

DTP*439*D8*20100402~

REF*D9*987654321~

HI*ABK:847.0~

NM1*DN*1*SMITH*DANIEL****XX*1123456789~

NM1*82*1*JOHNS*JOHN*I**MD*XX*1987654321~

LX*1~

SV1*HC:99213*150*UN*1***1~

DTP*472*D8*20230401~

SE*26*0001~

GE*1*123456~

IEA*1*000000123~

• ISA/GS Segments: Identify sender and receiver details.

• BHT Segment: Defines transaction purpose and date.

• NM1 Segments: Provide names and IDs of providers, payers, and patients.

• CLM Segment: Contains claim information, including the total charge.

* REF*SY segment: Patient's Social Security number

* REF*Y4 segment: Claim number

• SV1 Segment: Details the medical service being billed (CPT code 99213 in this case).

• HI Segment: Lists diagnosis codes.

• DTP Segment: Specifies the date of service.

How Simpliclaim Helps with 837 EDI Files:

• Automates the generation and submission of 837P & 837I files.

• Validates claims to reduce errors and rejections.

• Tracks claim statuses in real time.

• Ensures compliance with payer-specific EDI requirements.