User Guide — ANSI Standard Claim Formats
athenaOne for Hospitals & Health Systems
athenahealth formats and submits most claims electronically using the ANSI standard electronic claim formats that are mandated by HIPAA.
Electronic claim
forms — ANSI Standard Claim Formats
- Professional Health Care Claim (ASC X12N 837 (004010X098A1)) — Used to submit professional healthcare claims and/or encounters
- Institutional (ASC X12N 837 (004010X096A1)) — Used to submit institutional healthcare claims and/or encounters
- Health Care Payment and Remittance Advices (ASC X12N 835)
- Health Care Eligibility Benefit Inquiry and Response (ASC X12N 270/271)
- Health Claims Status Inquiries and Responses (ASC X12N 276/277)
- Referral Certification and Authorization (ASC X12N 278)
- Benefit Enrollment and Maintenance (ASC X12N 834)
- Health Plan Premium Payments (ASC X12N 820)
For the standard paper claim format, see CMS-1500 Form Reference.