HIPAA Electronic Transactions Standards

The Electronic Transaction & Code Set Standards include, among other things, the following:

  • Health claims or equivalent encounter information (Transaction Type 837).
  • Health care payment and remittance advice (Transaction Type 835).
  • Eligibility for a health plan (Transaction Types 270 and 271).

ANSI, the American National Standards Institute, created the standard formats for all of these transactions. create claim files for Medicare in version 4010, as required by HIPAA.  Primary Billing Service, Inc is able to create claim files for Medicare and other payors in version 4010, as required by HIPAA.

Health plans are required to conduct electronic transactions with healthcare providers, on or before the compliance date required under HIPAA. The compliance date for the Electronic Transaction Standards provisions of HIPAA was October, 16, 2002, or one year thereafter if insurer requests extension from the federal government.

When we submit your claims you can always be assured that we will be able to create them in the required format so that there will not be a delay of your cash flow.  We strive to stay on the cutting edge of technology.


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