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What is an 837 file?

Flow diagram showing an 837 claim followed by a 999 acknowledgment, a 277CA claim acknowledgment and an 835 remittance, with two rejection off-ramps marked

An 837 file is the electronic claim (X12 EDI) providers send to payers. 837P vs 837I, how to read one, and a worked example.

What is electronic remittance advice (ERA)?

Annotated sample electronic remittance advice showing trace number, claim status, CO-45 contractual adjustment, CO-197 denial, plan paid, PR-2 coinsurance and a provider-level recoupment

An electronic remittance advice (ERA) is the electronic file a health plan sends to explain how it processed your claims. Its standard format is the HIPAA 835, which is why ERA and 835 file get used interchangeably. CMS defines it as an explanation from a health plan to a provider about a claim payment. After […]

CPT code 21432: Open treatment of craniofacial separation (LeFort III)

CPT code 21432 describes the open treatment of craniofacial separation (LeFort III type); with wiring and/or internal fixation. That is the descriptor published by the American Medical Association’s CPT Editorial Panel in the AMA CPT code set. Two elements of it carry the whole code. The injury must be a LeFort III craniofacial separation, and […]

ICD-10 Code O61.1: Failed instrumental induction of labor

ICD-10 Code O61.1 is a billable ICD-10-CM diagnosis code for failed instrumental induction of labor. It applies when a mechanical or surgical attempt to start labor does not produce active labor. The code is valid for female patients aged 12 through 55. Most O61 coding errors come from one decision. Oxytocin and prostaglandin failures belong […]

Medicare Consent to Release form: Free template

Download your free Medicare Consent to Release form This is the CMS form that authorizes release of Medicare claim and entitlement records to a named representative. It covers beneficiary details, representative details, the scope of release, and the expiration date. Download template The Medicare Consent to Release (CTR) form authorizes CMS to release a beneficiary’s […]

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