EDI 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
- 0100Transaction Set HeaderMandatoryMax 1
To indicate the start of a transaction set and to assign a control number
- 0200Beginning SegmentMandatoryMax 1
To indicate the beginning of a transaction set
- 1000 Loop MandatoryRepeat 2
- 0300Party IdentificationMandatoryMax 1
To identify a party by type of organization, name, and code
- 0400Additional Name InformationOptionalMax 1
To specify additional names
- 0500Party LocationOptionalMax 1
To specify the location of the named party
- 0600Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 0700Administrative Communications ContactOptionalMax 1
To identify a person or office to whom administrative communications should be directed
- 0300Party IdentificationMandatoryMax 1
Detail
- 2000 Loop MandatoryRepeat >1
- 0100TraceMandatoryMax 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 DataOptionalMax 1
To supply information common to all services of a claim
- 0300Date or Time or PeriodOptionalMax 2
To specify any or all of a date, a time, or a time period
- 0400Request ValidationOptionalMax 1
To specify the validity of the request and indicate follow-up action authorized
- 2100 Loop OptionalRepeat 4
- 0500Individual or Organizational NameMandatoryMax 1
To supply the full name of an individual or organizational entity
- 0600Additional Name InformationOptionalMax 1
To specify additional names
- 0700Party LocationOptionalMax 1
To specify the location of the named party
- 0800Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 0900Reference InformationOptionalMax 9
To specify identifying information
- 1000Administrative Communications ContactOptionalMax 1
To identify a person or office to whom administrative communications should be directed
- 1100Date or Time or PeriodOptionalMax 1
To specify any or all of a date, a time, or a time period
- 0500Individual or Organizational NameMandatoryMax 1
- 2200 Loop OptionalRepeat 999
- 1200Service InformationMandatoryMax 1
To supply payment and control information to a provider for a particular service
- 1300Date or Time or PeriodOptionalMax 1
To specify any or all of a date, a time, or a time period
- 1200Service InformationMandatoryMax 1
- 0100TraceMandatoryMax 1
- 1400Transaction Set TrailerMandatoryMax 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)