Generate compliant claims, route to any clearinghouse, and get remittance back without building X12 from scratch.
Most healthcare apps don’t need to become claims clearinghouses. They need to submit claims to one and get remittance back. That’s the connector problem — not the processing problem.
X12 837 (claim submission) and 835 (electronic remittance advice) are the HIPAA-mandated transaction sets for claims. ConnectHealth handles the entire connector layer: format your data into a valid 837, route it through Availity or Stedi, receive the 835, and post it back to your system in a format you can use.
The 837 is the electronic claim your system sends to a clearinghouse, which validates and routes it to the payer. Three transaction types: 837P (professional/physician billing), 837I (institutional/hospital/facility), 837D (dental). ConnectHealth generates all three.
The 835 is the payer's response after adjudication what was paid, what was denied, adjustment reason codes, and contractual amounts. Also called the ERA (Electronic Remittance Advice). ConnectHealth receives the 835, parses the X12 loops, and surfaces the data your system can post against.
From claim creation to payment posting, ConnectHealth handles formatting, routing, adjudication responses and normalized ERA data.
Patient demographics, provider NPI, procedure codes, diagnosis codes, payer ID and service dates.
The claim is formatted into valid HIPAA 5010 X12 loops and segments, including payer and clearinghouse companion-guide requirements.
Use Availity for broad payer reach or Stedi for a REST-first, developer-friendly EDI workflow. ConnectHealth manages routing and delivery.
The clearinghouse validates and forwards the 837. The payer adjudicates the claim and returns an X12 835 remittance response.
Payment amounts, denial codes, CAS segments and NPI-level details are extracted and returned as normalized JSON.
Normalized remittance data appears in your RCM platform for payment posting, denial follow-up and secondary billing.
Physician services, outpatient procedures, telehealth visits, DME orders. Most digital health apps submit 837P. Loops: NM1 (providers/subscribers), CLM (claim), SV1 (service lines), DTP (dates), REF (identifiers).
Hospital inpatient/outpatient, SNF, home health, hospice claims. CMS 1450 (UB-04) equivalent in X12. Loops: NM1, CLM, UB04-specific CLM05 facility type codes, SV2 (institutional service lines).
Pre-visit eligibility sweep. Catch coverage changes between booking and arrival. Reduce day-of denials by resolving eligibility issues 24–48 hours out.
Verify plan covers the service type before provisioning. Handle state-to-state plan variation for telehealth.
Largest clearinghouse network in the US connects to 2,400+ payers including Medicare, Medicaid (all states), and major commercial plans. ConnectHealth routes 837s through Availity's clearinghouse API and receives 835s back on the same channel. Availity's real-time claim status (277CA) is also available for acknowledgement tracking.
Developer-first EDI clearinghouse. REST API over raw X12 — you send JSON, Stedi handles X12 translation. ConnectHealth uses Stedi's modern API surface as an alternative path for teams building on contemporary stacks. Faster to integrate, same payer reach for major networks.
HIPAA mandates ASC X12 5010 for all covered transactions but companion guides differ per payer, and some Medicare submissions use variations. ConnectHealth handles:
Current HIPAA mandate, what ConnectHealth generates by default
per-payer loop/segment requirements layered on top of the base standard
If your app also handles pharmacy billing, this routes to a separate transaction set
ICD-10-CM, CPT/HCPCS, NDC, NPI format checks before transmission (catches errors that would generate 277 rejections)
The X12 837 is the HIPAA electronic claim the digital equivalent of a paper CMS-1500 (for professional) or UB-04 (for institutional). It's the standard format for submitting a healthcare claim to a payer or clearinghouse. 837P covers professional/physician billing; 837I covers institutional (hospital/facility); 837D covers dental.
The X12 835 is the Electronic Remittance Advice (ERA) the payer's response after adjudication. It tells you what was paid, what was denied, and why, using standard reason codes and adjustment codes. It's the digital equivalent of an Explanation of Benefits (EOB) on the provider side.
No. ConnectHealth is the connector layer it builds and transmits the 837 and receives and parses the 835. Claim scrubbing (edit checks, LCD/NCD validation, modifier rules) and denial management workflows live in your RCM platform. ConnectHealth gives your RCM platform clean, structured 835 data to work with.
Availity and Stedi are the primary pathways. Availity covers 2,400+ payers including all major commercial plans and government programs. Stedi offers a REST-first EDI API for modern tech stacks. Payer-direct connections are available for high-volume payers where required.
No. ConnectHealth's clearinghouse connectivity is part of the platform you don't manage your own clearinghouse contracts. You connect through our API; we handle clearinghouse enrollment and routing.
Eligibility verification (270/271) is the step before claim submission, confirm the patient is covered before you bill. ConnectHealth handles both.
Yes. X12 5010 is the HIPAA-mandated transaction standard for electronic claims. ConnectHealth generates claims that comply with the base 5010 standard plus per-payer companion guide requirements. PHI in transit is encrypted; PHI at rest stays in your AWS VPC. BAA available.
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