274 Healthcare Provider Information

Functional Group PW

X12N Insurance Subcommittee

This X12 Transaction Set 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. Such exchanges include the transmitting, inquirying, or responding to an inquiry. Healthcare provider information is routinely exchanged for the purpose of 1) maintaining provider data bases for claim adjudication, provider directories, patient referrals, and reporting provider information, 2) submitting an application to join a provider organization or provider network such as, but not limited to, 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
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning of Hierarchical TransactionMandatory
Max 1
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
0300
Date/Time ReferenceOptional
Max 1
To specify pertinent dates and times
0400
Administrative Communications ContactOptional
Max 1
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
2000 Loop
Repeat >1
0100
Hierarchical LevelMandatory
Max 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.
0200
TraceOptional
Max 1
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.
0250
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
2100 Loop
Repeat >1
0300
Individual or Organizational NameMandatory
Max 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.
0500
Administrative Communications ContactOptional
Max >1
To identify a person or office to whom administrative communications should be directed
0600
Demographic InformationOptional
Max 1
To supply demographic information
0700
Monetary Amount InformationOptional
Max 20
To indicate the total monetary amount
0800
Activity or Process InformationOptional
Max >1
To provide information on activity or process
0900
Degree RecordOptional
Max 9
To provide information about an educational institution's academic award
1000
Additional Individual Demographic InformationOptional
Max 1
To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student
1100
Language UseOptional
Max 9
To specify language, type of usage, and proficiency or fluency
1200
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
1250
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
1300
TextOptional
Max >1
To specify textual data
1400
Quantity InformationOptional
Max 99
To specify quantity information
1500
Work ScheduleOptional
Max 99
To specify an individual's work schedule
1600
Conditions IndicatorOptional
Max 9
To supply information on conditions
1700
Health Care Services DeliveryOptional
Max 99
To specify the delivery pattern of health care services
1800
Basic Claim InformationOptional
Max 9
To identify information basic to the processing of any claims transaction
1900
Practice Detail InformationOptional
Max 1
To provide detail information on a health care provider's practice
2000
Hospital Affiliation DetailOptional
Max 1
To provide detail information describing a provider's affiliation to a specific hospital
2050
Account IdentificationOptional
Max 1
To specify account information
2110 Loop
Repeat >1
2100
Property or Entity IdentificationMandatory
Max 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.
2300
Party LocationOptional
Max 2
To specify the location of the named party
2400
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
2500
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
2550
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
2120 Loop
Repeat >1
2600
Industry Code IdentificationMandatory
Max 1
To identify standard industry codes
2700
Party IdentificationOptional
Max 2
To identify a party by type of organization, name, and code
2800
Business Professional TitleOptional
Max >1
To identify title of an individual within a company
2900
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
3000
Quantity InformationOptional
Max 1
To specify quantity information
3100
Yes/No QuestionOptional
Max >1
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
3150
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
2130 Loop
Repeat 99
3200
Health Care Provider LicenseMandatory
Max 1
To provide license, certification, accreditation, and registration information for health care providers
3300
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
3350
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
2140 Loop
Repeat >1
3400
Reference InformationMandatory
Max 1
To specify identifying information
3500
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
3550
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
2150 Loop
Repeat 9
3600
Employment PositionMandatory
Max 1
To describe employment position
3700
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
2160 Loop
Repeat >1
3710
Transaction Set Line NumberMandatory
Max 1
To reference a line number in a transaction set
3720
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
3730
Reference InformationOptional
Max 1
To specify identifying information
3740
Date or Time or PeriodOptional
Max 1
To specify any or all of a date, a time, or a time period
3750
Associated Object Type IdentificationOptional
Max 1
To identify attributes and status related to the object
3760
Binary Data StructureOptional
Max 1
To transfer binary data in a single data segment, convey a critical filter for transmission and allow identification of the end of the data segment through a count; there is no identification of the internal structure of the binary data in this segment
3770
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
3800
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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