EDI 837: The Health Care Claim, Explained

The EDI 837 is the Health Care Claim. It is how a medical provider — a clinic, hospital, or physician — bills an insurance payer for services delivered to a patient. It is one of the core HIPAA-mandated EDI transactions in U.S. healthcare.

The 837 / 835 cycle

The 837 does not travel alone. The payer responds with an 835 (Health Care Claim Payment/Remittance Advice), which explains how each claim was adjudicated — paid, denied, or applied to patient responsibility. Provider billing systems match the 835 back to the original 837.

Three flavors of 837

• 837P — Professional (physician/clinic claims)
• 837I — Institutional (hospital claims)
• 837D — Dental

Key segments

BHT — Beginning of Hierarchical Transaction

Opens the claim transaction with a reference number, date, and purpose.

NM1 — Names

Unlike retail EDI (which uses N1), healthcare uses NM1. The entity code says who: 41 submitter, 85 billing provider, PR payer, IL insured/subscriber, QC patient. A person's name is split into last/first; an organization's name sits in one field.

CLM — Claim Information

The claim itself: the claim ID and total charge amount. CLM*PATIENT-A*450.00.

SV1 — Professional Service Line

Each billed service, with a procedure code and charge. SV1*HC:99213*125.00*UN*1 = CPT 99213, $125.00, 1 unit.

A note on privacy

An 837 contains protected health information (PHI) — patient names, member IDs, diagnoses. That makes confidentiality essential. EdiPeek parses entirely in your browser and never uploads your file, which is why it is safe to use for inspecting real claims. Even so, avoid sharing unredacted PHI elsewhere.

Frequently asked questions