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EDI 275 Patient Information

Functional Group PI

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Patient Information Transaction Set (275) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate individual patient information requests and patient information (either solicited or unsolicited) between separate health care entities in a variety of settings to be consistent with confidentiality and use requirements. Patient information consists of demographic, clinical, and other supporting data.

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. To specify pertinent dates and times

  4. To uniquely identify a transaction to an application

  5. NM1 Loop Optional
    Repeat >1
    1. To supply the full name of an individual or organizational entity

      Loop NM1 identifies a single patient; it also identifies other entities or individuals which include the requester, responder or other organizations.
    2. To provide identification of an individual or entity

    3. To supply demographic information

    4. To specify the identifying characteristics of a provider

      The PRV segment is only used in Loop NM1 when identifying a requestor or responder who is also a provider.
    5. To identify a person or office to whom administrative communications should be directed

    6. To specify identifying information

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

    8. NX1 Loop Optional
      Repeat 5
      1. To define the attributes of a property or an entity

      2. To specify the location of the named party

      3. To specify the geographic place of the named party

Detail

Position
Segment
Name
Max use
  1. LX Loop Optional
    Repeat >1
    1. To reference a line number in a transaction set

    2. To uniquely identify a transaction to an application

      The TRN segment in Loop LX identifies a previously sent transaction set. The LX loop provides supporting or additional information for that item when TRN is used.
    3. To report the status, required action, and paid information of a claim or service line

      The STC segment in LX loop identifies the status and action requested in a prior transaction when the response is provided in this transaction.
    4. To supply the full name of an individual or organizational entity

      The NM1 segment in loop LX identifies an individual provider within a responder group.
    5. To specify the identifying characteristics of a provider

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

    7. To specify identifying information

    8. DTP Loop Optional
      Repeat >1
      1. To specify any or all of a date, a time, or a time period

      2. To specify categories of patient information service

      3. To describe a product or process in coded or free-form format

      4. EFI Loop Optional
        Repeat 1
        1. To provide basic information about the electronic format of the interchange data

        2. To transfer binary data in a single data segment 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

  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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