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EDI 837: Definition and Healthcare Context
Full name: EDI 837 Health Care Claim Transaction
The EDI 837 is a HIPAA-standard electronic data interchange format for submitting health care claims. Three transaction sets exist: 837P (Professional, based on CMS-1500), 837I (Institutional, based on UB-04), and 837D (Dental). Maintained by ASC X12 and implemented under HIPAA Administrative Simplification, the 837 replaced paper claims for covered transactions. Clearinghouses translate provider billing software output into X12 837 format for payer submission. CMS requires the 837 for all Medicare claims.
Last updated: 2026-07-11Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.
How it’s used
- CMS PECOS Medicare Provider Enrollment: providers enrolled in Medicare submit claims in 837 format to their MAC — PECOS enrollment and PTAN assignment are prerequisites for claim acceptance.
- ASC X12 and HIPAA Administrative Simplification: the 837 is maintained by ASC X12 and mandated under HIPAA, replacing paper claims for covered electronic transactions.
- Electronic remittance (835 / ERA): every accepted 837 claim is answered by an 835 remittance, the paired transaction that reports payment back to the provider.
Frequently asked questions
- What is EDI 837?
- EDI 837 is the HIPAA-standard electronic claim format for submitting health care claims. Three variants cover professional (837P), institutional (837I), and dental (837D) claims.
- Is EDI 837 required for Medicare?
- Yes. CMS requires the 837 EDI transaction for all Medicare claims submitted electronically. Paper claims are permitted only in limited circumstances.
- What is the difference between 837P and 837I?
- 837P (Professional) is used by physicians and other outpatient providers; 837I (Institutional) is used by hospitals, skilled nursing facilities, and other inpatient/facility providers.