Accredited ACH Professional (AAP) Practice Exam

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Which ANSI ASC X12 transaction set is used for health care payments?

ANSI ASC X12.820
ANSI ASC X12.835
ANSI ASC X12.813
ANSI ASC X12.823

The correct answer is: ANSI ASC X12.835

The ANSI ASC X12.835 transaction set is specifically designed for health care payment recommendations and remittance advice. This transaction set is utilized by health care payers to convey the details regarding the payment they are making for healthcare services rendered, including information about deducted amounts, adjustments, and the reasons behind those adjustments. The 835 transaction set facilitates the electronic communication of payments made to providers, ensuring that they receive detailed information regarding the status of their claims and payments. It helps streamline the reconciliation process for healthcare providers, allowing them to match payments to individual claims easily, which is crucial in the healthcare industry for accurate accounting and financial management. In contrast, the other transaction sets mentioned serve different purposes. For example, ANSI ASC X12.820 is generally used for payment orders or remittance; ANSI ASC X12.813 and ANSI ASC X12.823 are used for other specific financial or health care transactions that are not directly related to payment processing. Thus, the 835 is the correct choice for health care payments.