274 Healthcare Provider Information

Functional Group PW

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Healthcare Provider Information Transaction Set (274) for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to exchange demographic and educational/professional qualifications about healthcare providers between providers, provider networks or any other entity that maintains or verifies healthcare provider information. Healthcare provider information is routinely exchanged for the purpose of 1) maintaining provider data bases for claim adjudication, provider directories, patient referrals, and report provider information 2) submitting an application to join a provider organization or provider network such as a hospital, preferred provider organization (PPO) or health maintenance organization (HMO) and 3) verifying credentials such as educational/professional qualifications, licenses, and malpractice coverage/history.

Heading

Position
Segment
Name
Max use
  1. To indicate the start of a transaction set and to assign a control number

  2. To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time

  3. To specify pertinent dates and times

  4. To identify a person or office to whom administrative communications should be directed

    The PER segment is used to supply the sender's point of contact to the receiver.

Detail

Position
Segment
Name
Max use
  1. 2000 Loop Mandatory
    Repeat >1
    1. To identify dependencies among and the content of hierarchically related groups of data segments

      Valid hierarchical level codes for this transaction set are information source, information receiver, provider, group and site of service.
    2. To uniquely identify a transaction to an application

      The TRN segment is used to identify trace numbers that provide an electronic link between this transaction and other transactions.
    3. 2100 Loop Mandatory
      Repeat >1
      1. To supply the full name of an individual or organizational entity

        The NM1 segment is used to identify individuals and entities related to the hierarchical level identified by HL03.
      2. To specify additional names

      3. To identify a person or office to whom administrative communications should be directed

      4. To supply demographic information

      5. To indicate the total monetary amount

      6. To provide information on activity or process

      7. To provide the receiving institution or agency notice of academic awards made to the student whose record is being transmitted

      8. To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student

      9. To specify language, type of usage, and proficiency or fluency

      10. To specify any or all of a date, a time, or a time period

      11. To specify textual data

      12. To specify quantity information

      13. To specify an individual's work schedule

      14. To supply information on conditions

      15. To specify the delivery pattern of health care services

      16. To identify information basic to the processing of any claims transaction

      17. To provide detail information on a health care provider's practice

      18. To provide detail information describing a provider's affiliation to a specific hospital

      19. 2110 Loop Optional
        Repeat >1
        1. To define the attributes of a property or an entity

          Loop 2110 provides multiple addresses related to the entity identified in the NM1 segment. The NX1 segment provides the type of address for each iteration of the loop. For instance, billing service or place of business.
        2. To specify additional names

        3. To specify the location of the named party

        4. To specify the geographic place of the named party

        5. To identify a person or office to whom administrative communications should be directed

      20. 2120 Loop Optional
        Repeat >1
        1. Code to transmit standard industry codes

        2. To identify a party by type of organization, name, and code

        3. To identify title of an individual within a company

        4. To specify any or all of a date, a time, or a time period

        5. To specify quantity information

        6. To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition

      21. 2130 Loop Optional
        Repeat 99
        1. To provide license, certification, accreditation, and registration information for health care providers

        2. To specify any or all of a date, a time, or a time period

      22. 2140 Loop Optional
        Repeat >1
        1. To specify identifying information

        2. To specify any or all of a date, a time, or a time period

      23. 2150 Loop Optional
        Repeat 9
        1. To describe employment position

        2. To specify any or all of a date, a time, or a time period

  2. To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference is provided for marketing purposes and is free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.