Which transactions identify professional vs institutional claims and how are they submitted?

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Multiple Choice

Which transactions identify professional vs institutional claims and how are they submitted?

Understand that professional and institutional claims use different HIPAA electronic transaction sets, and the path to submission is typically through a Clearinghouse. The professional claim type is identified by the 837 Professional transaction, which is used for clinician services and payer billing of professional fees. The institutional claim type uses the 837 Institutional transaction, designed for facility charges such as hospital services. In many workflows, both types are submitted electronically via a Clearinghouse, which aggregates claims, runs standard edits, and forwards them to the appropriate payer. This route is common because it helps ensure consistency and streamlines routing across multiple payers.

Understand that professional and institutional claims use different HIPAA electronic transaction sets, and the path to submission is typically through a Clearinghouse. The professional claim type is identified by the 837 Professional transaction, which is used for clinician services and payer billing of professional fees. The institutional claim type uses the 837 Institutional transaction, designed for facility charges such as hospital services. In many workflows, both types are submitted electronically via a Clearinghouse, which aggregates claims, runs standard edits, and forwards them to the appropriate payer. This route is common because it helps ensure consistency and streamlines routing across multiple payers.

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