How to Submit Electronic Claims in HIPAA 837 Format


The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 in an effort to reduce the administrative costs of health care. The legislation requires health insurance payers to comply with the Electronic Data Interchange (EDI) standards for health care, as established by the Secretary of Health and Human Services. In order to achieve the potential administrative costs savings with EDI, standard transactions and code sets have been developed and will be implemented by all covered entities engaged in the electronic exchange of data. HIPAA mandates the use of standard transactions and code sets for covered entities that choose to conduct business electronically.

Information for Users of a Practice Management System or a 3rd Party Biller

All EDI Submitters also need to follow Beacon’s Companion Guide, which provides the information necessary to submit claims/transactions electronically to Beacon and is used in conjunction with the ANSI X 12N Implementation Guide. Beacon’s Companion Guide supplements, but does not replace or contradict, any requirements in the Implementation Guide.

Claims Testing

Claims testing is available for ALL Providers and Trading Partners. Instructions can be found in Beacon’s Companion Guide.

Submitting Compliant 5010 Claims

Upon passing testing with Beacon, you can begin submitting HIPAA 837 claims.

If you currently use a Practice Management System (PMS), you will need the ANSI X 12N Implementation Guide and applicable addenda, which detail specific requirements for processing electronic data within payer systems.

HIPAA Compliance Testing

According to the Centers for Medicare and Medicaid Services (CMS), you are responsible for ensuring that EDI transactions comply with HIPAA regulations.

To help you address your HIPAA EDI obligations as efficiently as possible, Beacon recommends Claredi, the nation’s leading provider of HIPAA transaction and code set testing and certification.

Claredi, an independent certifying agency, is the testing and certification entity selected by CMS for their own compliance. Using the same certification organization as Beacon reduces the potential for any transaction discrepancies.

For information on Claredi’s services, just visit Claredi’s Web site at


Electronic Claims Submission/EDI Helpdesk
If you have a technical question about ProviderConnect or EDI Claims Link, please contact the EDI Helpdesk

Phone: (888) 247-9311 from 8 a.m. – 6 p.m. ET
Fax: (866) 698-6032
Mailing Address: Beacon Health Options
Attn: EDI Helpdesk
PO Box 1287
Latham, NY 12110