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
/institutionalclaims/v1/validation endpoint allows the submitter to run claims through extensive repositories of rules and logic to correct potential errors before sending to the payer. It saves significant time and enables higher rates of acceptance on initial claim submissions.
We also provide EDI-to-JSON mapping, so you can quickly find out the EDI segments and loops that map to each JSON attribute in the API.
Please see the API FAQs section for tips and solutions to some of the most common questions asked by customers, developer community, and internal staff about the use of our APIs.