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274Healthcare Provider Information

This X12 Transaction Set contains the format and establishes the data contents of the Healthcare Provider Information Transaction Set (274) for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to exchange demographic and educational/professional qualifications about healthcare providers between providers, provider networks or any other entity that maintains or verifies healthcare provider information. Such exchanges include the transmitting, inquirying, or responding to an inquiry. Healthcare provider information is routinely exchanged for the purpose of 1) maintaining provider data bases for claim adjudication, provider directories, patient referrals, and reporting provider information, 2) submitting an application to join a provider organization or provider network such as, but not limited to, a hospital, preferred provider organization (PPO) or health maintenance organization (HMO), and 3) verifying credentials such as educational/professional qualifications, licenses, and malpractice coverage/history.

  • ST
    Transaction Set Header
    M必须(Mandatory)
    Repeat 1

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

  • BHT
    Beginning of Hierarchical Transaction
    M必须(Mandatory)
    Repeat 1

    To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time

  • DTM
    Date/Time Reference
    O可选(Optional)
    Repeat 1

    To specify pertinent dates and times

  • PER
    Administrative Communications Contact
    O可选(Optional)
    Repeat 1

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

  • HLLoop1Hierarchical Level LOOPM必须(Mandatory)Repeat > 1
    HLTRNAAANM1Loop1
    • HL
      Hierarchical Level
      M必须(Mandatory)
      Repeat 1

      To identify dependencies among and the content of hierarchically related groups of data segments

    • TRN
      Trace
      O可选(Optional)
      Repeat 1

      To uniquely identify a transaction to an application

    • AAA
      Request Validation
      O可选(Optional)
      Repeat 1

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

    • NM1Loop1Individual or Organizational Name LOOPM必须(Mandatory)Repeat > 1
      NM1N2PERDMGAMTAPIDEGINDLUIDTPAAAMTXQTYWSCRCHSDBCIPDIHADNX1Loop1LQLoop1HPLLoop1REFLoop1EMSLoop1
      • NM1
        Individual or Organizational Name
        M必须(Mandatory)
        Repeat 1

        To supply the full name of an individual or organizational entity

      • N2
        Additional Name Information
        O可选(Optional)
        Repeat > 1

        To specify additional names

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat > 1

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

      • DMG
        Demographic Information
        O可选(Optional)
        Repeat 1

        To supply demographic information

      • AMT
        Monetary Amount Information
        O可选(Optional)
        Repeat 20

        To indicate the total monetary amount

      • API
        Activity or Process Information
        O可选(Optional)
        Repeat > 1

        To provide information on activity or process

      • DEG
        Degree Record
        O可选(Optional)
        Repeat 9

        To provide information about an educational institution's academic award

      • IND
        Additional Individual Demographic Information
        O可选(Optional)
        Repeat 1

        To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student

      • LUI
        Language Use
        O可选(Optional)
        Repeat 9

        To specify language, type of usage, and proficiency or fluency

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 9

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

      • AAA
        Request Validation
        O可选(Optional)
        Repeat 1

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

      • MTX
        Text
        O可选(Optional)
        Repeat > 1

        To specify textual data

      • QTY
        Quantity Information
        O可选(Optional)
        Repeat 99

        To specify quantity information

      • WS
        Work Schedule
        O可选(Optional)
        Repeat 99

        To specify an individual's work schedule

      • CRC
        Conditions Indicator
        O可选(Optional)
        Repeat 9

        To supply information on conditions

      • HSD
        Health Care Services Delivery
        O可选(Optional)
        Repeat 99

        To specify the delivery pattern of health care services

      • BCI
        Basic Claim Information
        O可选(Optional)
        Repeat 9

        To identify information basic to the processing of any claims transaction

      • PDI
        Practice Detail Information
        O可选(Optional)
        Repeat 1

        To provide detail information on a health care provider's practice

      • HAD
        Hospital Affiliation Detail
        O可选(Optional)
        Repeat 1

        To provide detail information describing a provider's affiliation to a specific hospital

      • NX1Loop1Property or Entity Identification LOOPO可选(Optional)Repeat > 1
        NX1N2N3N4PER
        • NX1
          Property or Entity Identification
          M必须(Mandatory)
          Repeat 1

          To define the attributes of a property or an entity

        • N2
          Additional Name Information
          O可选(Optional)
          Repeat 1

          To specify additional names

        • N3
          Party Location
          O可选(Optional)
          Repeat 2

          To specify the location of the named party

        • N4
          Geographic Location
          O可选(Optional)
          Repeat 1

          To specify the geographic place of the named party

        • PER
          Administrative Communications Contact
          O可选(Optional)
          Repeat 1

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

      • LQLoop1Industry Code Identification LOOPO可选(Optional)Repeat > 1
        LQN1TPBDTPQTYYNQAAA
        • LQ
          Industry Code Identification
          M必须(Mandatory)
          Repeat 1

          To identify standard industry codes

        • N1
          Party Identification
          O可选(Optional)
          Repeat 2

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

        • TPB
          Business Professional Title
          O可选(Optional)
          Repeat > 1

          To identify title of an individual within a company

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 9

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

        • QTY
          Quantity Information
          O可选(Optional)
          Repeat 1

          To specify quantity information

        • YNQ
          Yes/No Question
          O可选(Optional)
          Repeat > 1

          To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition

        • AAA
          Request Validation
          O可选(Optional)
          Repeat 1

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

      • HPLLoop1Health Care Provider License LOOPO可选(Optional)Repeat 99
        HPLDTPAAA
        • HPL
          Health Care Provider License
          M必须(Mandatory)
          Repeat 1

          To provide license, certification, accreditation, and registration information for health care providers

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat > 1

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

        • AAA
          Request Validation
          O可选(Optional)
          Repeat 1

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

      • REFLoop1Reference Information LOOPO可选(Optional)Repeat > 1
        REFDTPAAA
        • REF
          Reference Information
          M必须(Mandatory)
          Repeat 1

          To specify identifying information

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 9

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

        • AAA
          Request Validation
          O可选(Optional)
          Repeat 1

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

      • EMSLoop1Employment Position LOOPO可选(Optional)Repeat 9
        EMSDTP
        • EMS
          Employment Position
          M必须(Mandatory)
          Repeat 1

          To describe employment position

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 9

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

  • SE
    Transaction Set Trailer
    M必须(Mandatory)
    Repeat 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)

Segment
X12 EDI Release 00601
STTransaction Set Header
To indicate the start of a transaction set and to assign a control number
Elements
  • ST01143Transaction Set Identifier Code
    ID
    M必须(Mandatory)
    Min 3 / Max 3

    Code uniquely identifying a Transaction Set

    Codes (320)
  • ST02329Transaction Set Control Number
    AN
    M必须(Mandatory)
    Min 4 / Max 9

    Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

  • ST031705Implementation Convention Preference
    AN
    O可选(Optional)
    Min 1 / Max 9

    Reference assigned to identify Implementation Convention

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