Transaction Set 186 |
Used by testing laboratories to provide test results and associated
information to insurance companies for life and health insurance
underwriting. |
| LaboratoryReporting
(X12.284) |
| PP408 - ASCX12N |
| Status:In Ballot - Published - 3040 |
Transaction Set 253 |
Can be used to transmit healthcare financial, and enrollment data
from federally qualified health maintenance organizations (HMO)
and comprehensive medical plans (CMP) to Federal and State Agencies. |
| Data Reporting Requirements (X12.374) |
| PP592 - ASCX12N |
| Status: In Development |
Transaction Set 270 |
Used to inquire about healthcare eligibility and benefits associated
with a subscriber or a dependent under the subscriber's policy. |
| Eligibility, Coverage or Benefit Inquiry
(X12.281) |
| PP405 - ASCX12N |
| Status: Published - 3031 |
Transaction Set 271 |
Used to respond to the Eligibility, Coverage, or Benefit Inquiry
Transaction Set (270) and provides information about or changes
to healthcare eligibility or benefits. |
| Eligibility, Coverage or Benefit Information
(X12.282) |
| PP406 - ASCX12N |
| Status: Published - 3031 |
Transaction Set 274 |
Can be used to exchange healthcare provider demographic, educational
and professional qualifications between providers, provider networks,
or any other entity that maintains or verifies provider information. |
| Healthcare Provider Information (X12.398) |
| PP633 - ASCX12N |
| Status: Status: In Development |
Transaction Set 275 |
Used by providers, payors, sponsors, and regulatory bodies to provide
demographic, clinical, continuity of care, and other patient healthcare
information. |
| Patient Information (X12.315) |
| PP470 - ASCX12N |
| Status: Published - 3052 |
Transaction Set 276 |
Used by a provider, recipient of healthcare products or services,
or an authorized agent to request from a healthcare payor the status
of a healthcare claim or encounter. |
| Healthcare Claim Status Request (X12.316) |
| PP471 - ASCX12N |
| Status: Published - 3040 |
Transaction Set 277 |
Used by a healthcare payor or authorized agent to notify a provider,
recipient, or authorized agent regarding the status of or to request
additional information from the provider about a healthcare claim
or encounter. |
| Healthcare Claim Status Notification (X12.317) |
| PP472 - ASCX12N |
| Status: Published - 3040 |
Transaction Set 278 |
To communicate the result of a healthcare service review performed
by a healthcare review information source (insurer, plan sponsor,
utilization review organization) to physicians, hospitals, medical
facilities, or payors. |
| Healthcare Services Review Information
(X12.336) |
| PP520 - ASCX12N |
| Status: Published - 3050 |
Transaction Set 500 |
Can be used by manufacturers, user facilities, distributors, healthcare
professionals, and consumers, who are involved with medications
and devices, to make voluntary, mandatory, baseline, semi-annual
and annual reports on medication and device adverse effects and
product problems. |
| Medical Event Reporting (X12.501) |
| PP653 - ASCX12G |
| Status: In Ballot - Published |
Transaction Set 834 |
Used to exchange employee insurance enrollment information between
an insurance sponsor, payor, and third-party
administrator. |
| Benefit Enrollment and Maintenance (X12.84) |
| PP227 - ASCX12N |
| Status: Published - 3021 |
Transaction Set 835 |
Used to make a payment, send an explanation of benefits remittance
advice, or make a payment and send an explanation of benefits remittance
advice from a health insurer to a healthcare provider directly or
via a financial institution. |
| Healthcare Claim Payment/Advice (X12.85) |
| PP228 - ASCX12N |
| Status: Published - 3020 |
Transaction Set 837 |
Used to submit healthcare claim billing information from healthcare
service providers to payors, either directly
or via intermidiary billers and claims clearinghouses. Used to transmit
healthcare claims and billing payment information between payors
with different payment responsibilities where coordination of benefits
is required. |
| Healthcare Claim (X12.86) |
| PP229 - ASCX12N |
| Status: Published - 3030 |
EDI
standard body. Some of the healthcare-relevant “transaction sets”
follow,