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269Health Care Benefit Coordination Verification

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 and respond to Health Care Benefit coordination information such as claim identification, previous adjudication details, and adjudication verification from one Health Care Payer to another. The transaction can be used as a notification of benefit coordination information. When used as a request for verification of benefit coordination information, the 269 is the response to that request for benefit coordination information verification.

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

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

  • BGN
    Beginning Segment
    M必须(Mandatory)
    Repeat 1

    To indicate the beginning of a transaction set

  • N1Loop1Party Identification LOOPM必须(Mandatory)Repeat 2
    N1N2N3N4PER
    • N1
      Party Identification
      M必须(Mandatory)
      Repeat 1

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

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

      To specify additional names

    • N3
      Party Location
      O可选(Optional)
      Repeat 1

      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

  • TRNLoop1Trace LOOPM必须(Mandatory)Repeat > 1
    TRNCLPDTPAAANM1Loop1SVCLoop1
    • TRN
      Trace
      M必须(Mandatory)
      Repeat 1

      To uniquely identify a transaction to an application

    • CLP
      Claim Level Data
      O可选(Optional)
      Repeat 1

      To supply information common to all services of a claim

    • DTP
      Date or Time or Period
      O可选(Optional)
      Repeat 2

      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

    • NM1Loop1Individual or Organizational Name LOOPO可选(Optional)Repeat 4
      NM1N2N3N4REFPERDTP
      • 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

      • N3
        Party Location
        O可选(Optional)
        Repeat 1

        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

      • REF
        Reference Information
        O可选(Optional)
        Repeat 9

        To specify identifying information

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

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

      • 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

    • SVCLoop1Service Information LOOPO可选(Optional)Repeat 999
      SVCDTP
      • SVC
        Service Information
        M必须(Mandatory)
        Repeat 1

        To supply payment and control information to a provider for a particular service

      • 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

  • 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 00603
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 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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