269 Health Care Benefit Coordination Verification

Functional Group HV

X12N Insurance Subcommittee

This X12 Transaction Set contains the format and establishes the data contents of the Health Care Benefit Coordination Verification Transaction Set (269) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to transmit Health Care Benefit coordination information such as claim identification and previous payment from one Health Care Payer to another and report the positive or negative acknowledgment of payments.

Heading

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

  2. To indicate the beginning of a transaction set

  3. 1000 Loop Mandatory
    Repeat 2
    1. To identify a party by type of organization, name, and code

    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

Detail

Position
Segment
Name
Max use
  1. 2000 Loop Mandatory
    Repeat >1
    1. To uniquely identify a transaction to an application

      The TRN segment is used to uniquely identify and tie an inquiry to a response.
    2. To supply information common to all services of a claim

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

    4. To specify the validity of the request and indicate follow-up action authorized

    5. 2100 Loop Optional
      Repeat 4
      1. To supply the full name of an individual or organizational entity

      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 specify identifying information

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

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

    6. 2200 Loop Optional
      Repeat 999
      1. To supply payment and control information to a provider for a particular service

      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)

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