In HIPAA transaction standards, which statements describe 837 and 835?

• A. 837 is the claim submission format used for submissions; 835 is the diagnosis codes
• B. 837 is the patient eligibility inquiry; 835 is the claim submission format
• C. 837 is the interchange standard for claims submission; 835 is the explanation of benefits
• D. 837 is the scheduling code; 835 is the insurance card number

Answer: (C)

The main concept here is understanding how HIPAA transaction standards separate claim submission from payment communications. The 837 is the interchange standard used to submit health care claims electronically from the provider to the payer. The 835 is the remittance advice the payer sends back with payment details, including amounts paid, any adjustments, and denial reasons. It’s the provider-facing counterpart to payments, and while its content often aligns with what’s shown in an EOB, the 835 itself is the electronic payment/remittance message, not the patient-facing benefit clarification.

That’s why this pairing is the best fit: 837 handles submitting claims, and 835 handles communicating payments and adjustments. Other descriptions don’t match HIPAA transaction roles: eligibility inquiries are handled by the 270/271, not the 837; the claim submission format is 837, not 835; scheduling codes or insurance card numbers aren’t HIPAA transaction sets.