Institutional Outpatient Claims

The 837 Institutional Outpatient claim form is used by the following types of providers: home health, critical access, hospice, personal care, nurses in independent practice, and outpatient hospital.

The 837 Institutional Outpatient claim form has several screens that you will use to complete a Medicaid or Wisconsin Well Woman Program (WWWP) claim, depending on your provider type. These screens include:

• Headers 1-5.
• Service.
• Other Insurance.
• Other Insurance Adjustments.
• Medicare.
• Other Insurance/Medicare Service Adjustments.

Next — Completing New Institutional Outpatient Claims