Overview

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The ASC X12N Health Care Claim: Institutional (837i) transaction enables institutional healthcare providers to submit healthcare claims for a service or encounter. A healthcare claim includes patient information, related diagnoses, procedures performed or services provided, and any related charges. This API also translates standard X12 EDI 837i transactions to JSON so that it is more accessible to claim readers and developers.

Prior to submitting an institutional claim, the Institutional Claims Validation endpoint allows the submitter to run claims through extensive repositories of rules and logic in order to correct potential errors before to sending to the payer. It enables significant time savings and higher rates of acceptance on initial claim submissions.

We also provide EDI-to-JSON mapping documentation, so you can quickly find out the EDI segments and loops that map to each JSON attribute in the API.

Release NotesFAQ
View the Change Log/Release Notes for information about the history of programmatic updates for the Institutional Claims API.Check out our FAQ for help with specific questions about this API!