Billing • Regulated by HIPAA / Accredited Standards Committee X12
EDI 837P (Professional Healthcare Claim)
Definition: The standard electronic data interchange transaction format used by home care and healthcare providers to submit medical claims to insurance payers and Medicaid.
Regulatory Impact & Compliance Overview
The 837P format is the electronic equivalent of the paper CMS-1500 claim form. Home care agencies generate 837P claim files from verified EVV visits to submit billings directly to state Medicaid MMIS portals or clearinghouses.
Governing Authority
Enforced by HIPAA / Accredited Standards Committee X12 in United States. Compliance with these standards is legally required for all licensed and participating care providers.
Automated Compliance
How AsanWork Enforces EDI 837P (Professional Healthcare Claim)
AsanWork builds compliance directly into daily scheduling workflows. Hard compliance stops prevent un-vetted, un-screened, or non-credentialed staff from receiving shift allocations, ensuring 100% audit readiness.
Related United States Healthcare Terms
Regulation
21st Century Cures Act
A landmark federal healthcare law passed in 2016 designed to accelerate medical innovation, prevent health data blocking, and mandate Electronic Visit Verification for Medicaid home care.
Payroll
Blended Regular Rate (Overtime)
The weighted average hourly rate used to calculate FLSA overtime when a caregiver works at two or more different pay rates in the same workweek.
Regulation
CMS Conditions of Participation (CoPs)
Federal health and safety requirements that home health agencies and healthcare organizations must meet to begin and continue participating in Medicare and Medicaid programs.
Payroll
California Daily Overtime
A California state labor law requiring overtime pay of 1.5x regular pay for hours worked beyond 8 in a single day, and double pay for hours past 12.