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 and respond to Health Care Benefit coordination information such as claim identification, previous adjudication details, and adjudication verification from one Health Care Payer to another. The transaction can be used as a notification of benefit coordination information. When used as a request for verification of benefit coordination information, the 269 is the response to that request for benefit coordination information verification.

Heading

Position
Segment
Name
Max use
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning SegmentMandatory
Max 1
To indicate the beginning of a transaction set
1000 Loop
Repeat 2
0300
Party IdentificationMandatory
Max 1
To identify a party by type of organization, name, and code
0500
Party LocationOptional
Max 1
To specify the location of the named party
0600
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0700
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed

Detail

Position
Segment
Name
Max use
2000 Loop
Repeat >1
0100
TraceMandatory
Max 1
To uniquely identify a transaction to an application
The TRN segment is used to uniquely identify and tie an inquiry to a response.
0200
Claim Level DataOptional
Max 1
To supply information common to all services of a claim
0300
Date or Time or PeriodOptional
Max 2
To specify any or all of a date, a time, or a time period
0400
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
2100 Loop
Repeat 4
0500
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
0700
Party LocationOptional
Max 1
To specify the location of the named party
0800
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0900
Reference InformationOptional
Max 9
To specify identifying information
1000
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
1100
Date or Time or PeriodOptional
Max 1
To specify any or all of a date, a time, or a time period
2200 Loop
Repeat 999
1200
Service InformationMandatory
Max 1
To supply payment and control information to a provider for a particular service
1300
Date or Time or PeriodOptional
Max 1
To specify any or all of a date, a time, or a time period
1400
Transaction Set TrailerMandatory
Max 1
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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