837P Professional Health Insurance Claim Example; Commercial Insurance

“Professional” EDI transactions are used by all providers that are not hospitals. That is, doctors, physicians, physical therapists, etc., will all use this transaction type to submit their bills.

Note that dentists use a slightly different flavor of 837, called “837D”.

837P is based on the CMS-1500 form, that was used for manually submitting claims.

Below is an example of an 837P EDI transaction provided by X12. The example was updated to use ICD-10 codes.

It shows a claim submitted by “Ben Kildare Service” to “Key Insurance Company” for services provided in October 2016 to Ted Smith, who is a child of Jane Smith. Jane Smith is a subscriber.