Follow HIPAA guidelines to ensure successful claims processing

January 26, 2023

​When billing claims electronically via the 837 transactions, be sure to follow the guidelines set by the Health Insurance Portability and Accountability Act (HIPAA). Please refer to the instructions outlined in the Claims Resolution Matrix for Professional or Institutional claims to assist with resolving claim rejections.

We recently made changes to the front-end claim editing language to further align with the HIPAA guidelines. If you do not follow the guidelines when billing claims, you may begin to see rejections.

  • If you receive a rejection (A6/672 or A7/672), you will need to correct the way your 837 transaction was submitted.
  • If you currently follow the HIPAA guidelines, you should not see any changes to the claim edit process.