This Companion Guide provides information about the X12 837 Inbound COB Claims that is specific to L.A. Care, its Providers and its Trading Partners. Please note, this document provides requirements for COB data that need to be reported on an X12 837 in addition to claim information currently being sent to L.A. Care Health Plan.

Specific 837 data elements work together to coordinate benefits between Anthem and Medicare or other carriers. Following the Provider-to-Payer-to-Provider model; The provider sends the 837 to the primary payer. The primary payer adjudicates the claim and sends an 835 Payment Advice to the provider. The

Jan 30, 2018 · Companion Guides (CGs) may contain two types of data, instructions for electronic communications with the publishing entity (Communications/Connectivity Instructions) and supplemental information for creating transactions for the publishing entity while ensuring compliance with the associated ASC X12 IG (Transaction Instructions).

An inbound interchange control structure is the envelope that wraps all transaction data (ST-SE) sent to CSC for processing. Examples include 837 and 276 transactions.

The 837 defines what values submitters must use to signal payers that the Inbound 837 contains a reversal or correction to a claim that has previously been submitted for processing.

Implementation Guide 837 version 5010 and the Addenda (A1) for Health Care Claims have been established as the standard for claims transactions compliance.

The 837 transaction is designed to transmit one or more claims for each billing provider. The hierarchy of the looping structure is billing provider, subscriber, patient, claim level, and claim service line level.

The 837P inbound is the claim transaction sent from the trading partner to Louisiana Blue to request claim adjudication. We allow batch submissions of claim transactions.

This CG provides technical and connectivity specification for the 837 Health Care Claim: Professional transaction Version 005010A1.

Empire returns a 999 Interchange Acknowledgment to the submitter for every inbound 837 transaction received. Each transaction passes through edits to ensure that it is X12 compliant.