EDI 275 Patient Information

Functional Group PI

X12N Insurance Subcommittee

This X12 Transaction Set 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

1. 0100 · ST · Transaction Set Header · Max 1 · Mandatory

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

2. 0200 · BGN · Beginning Segment · Max 1 · Optional

   To indicate the beginning of a transaction set

3. 0300 · DTM · Date/Time Reference · Max 3 · Optional

   To specify pertinent dates and times

4. 0400 · TRN · Trace · Max 5 · Optional

   To uniquely identify a transaction to an application

5. NM1 Loop Optional Repeat >1

   1. 0500 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

      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. 0600 · IN1 · Individual Identification · Max 1 · Optional

      To provide identification of an individual or entity

   3. 0700 · DMG · Demographic Information · Max 3 · Optional

      To supply demographic information

   4. 0800 · PRV · Provider Information · Max 1 · Optional

      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. 0900 · PER · Administrative Communications Contact · Max 2 · Optional

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

   6. 1000 · REF · Reference Information · Max 15 · Optional

      To specify identifying information

   7. 1050 · DTP · Date or Time or Period · Max 1 · Optional

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

   8. NX1 Loop Optional Repeat 5

      1. 1100 · NX1 · Property or Entity Identification · Max 1 · Mandatory

         To define the attributes of a property or an entity

      2. 1200 · N3 · Party Location · Max 1 · Optional

         To specify the location of the named party

      3. 1300 · N4 · Geographic Location · Max 1 · Optional

         To specify the geographic place of the named party

Detail

1. LX Loop Optional Repeat >1

   1. 0100 · LX · Transaction Set Line Number · Max 1 · Mandatory

      To reference a line number in a transaction set

   2. 0150 · TRN · Trace · Max 1 · Optional

      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. 0175 · STC · Status Information · Max 1 · Optional

      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. 0200 · NM1 · Individual or Organizational Name · Max 1 · Optional

      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. 0300 · PRV · Provider Information · Max 1 · Optional

      To specify the identifying characteristics of a provider

   6. 0400 · PER · Administrative Communications Contact · Max 1 · Optional

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

   7. 0500 · REF · Reference Information · Max 5 · Optional

      To specify identifying information

   8. DTP Loop Optional Repeat >1

      1. 0600 · DTP · Date or Time or Period · Max 1 · Mandatory

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

      2. 0700 · CAT · Category of Patient Information Service · Max 1 · Optional

         To specify categories of patient information service

      3. 0800 · PID · Product/Item Description · Max 1 · Optional

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

      4. EFI Loop Optional Repeat 1

         1. 0900 · EFI · Electronic Format Identification · Max 1 · Mandatory

            To provide basic information about the electronic format of the interchange data

         2. 1000 · BIN · Binary Data Segment · Max 1 · Mandatory

            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. 1100 · SE · Transaction Set Trailer · Max 1 · Mandatory

   To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)