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.

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Heading

Position

Segment

Name

Max use

0100Transaction Set HeaderMandatory->Max 1

To indicate the start of a transaction set and to assign a control number

0200Beginning SegmentMandatory->Max 1

To indicate the beginning of a transaction set

1000 Loop Mandatory

Repeat 2

0300Party IdentificationMandatory->Max 1

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

0400Additional Name InformationOptional->Max 1

To specify additional names

0500Party LocationOptional->Max 1

To specify the location of the named party

0600Geographic LocationOptional->Max 1

To specify the geographic place of the named party

0700Administrative 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 Mandatory

Repeat >1

0100TraceMandatory->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.

0200Claim Level DataOptional->Max 1

To supply information common to all services of a claim

0300Date or Time or PeriodOptional->Max 2

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

0400Request ValidationOptional->Max 1

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

2100 Loop Optional

Repeat 4

0500Individual or Organizational NameMandatory->Max 1

To supply the full name of an individual or organizational entity

0600Additional Name InformationOptional->Max 1

To specify additional names

0700Party LocationOptional->Max 1

To specify the location of the named party

0800Geographic LocationOptional->Max 1

To specify the geographic place of the named party

0900Reference InformationOptional->Max 9

To specify identifying information

1000Administrative Communications ContactOptional->Max 1

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

1100Date or Time or PeriodOptional->Max 1

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

2200 Loop Optional

Repeat 999

1200Service InformationMandatory->Max 1

To supply payment and control information to a provider for a particular service

1300Date or Time or PeriodOptional->Max 1

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

1400Transaction 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)