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Transaction Set
in
X12 Release 004030

274 Healthcare Provider Information

Functional Group PW

This Draft Standard for Trial Use 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. Healthcare provider information is routinely exchanged for the purpose of 1) maintaining provider data bases for claim adjudication, provider directories, patient referrals, and report provider information 2) submitting an application to join a provider organization or provider network such as 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.

Heading

Sequence
Segment
Name
Max use
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning of Hierarchical TransactionMandatory
Max 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
0300
Date/Time Reference
Max 1
To specify pertinent dates and times
0400
Administrative Communications Contact
Max 1
To identify a person or office to whom administrative communications should be directed
The PER segment is used to supply the sender's point of contact to the receiver.

Detail

Sequence
Segment
Name
Max use
2000 Loop
Repeat >1
0100
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
Valid hierarchical level codes for this transaction set are information source, information receiver, provider, group and site of service.
0200
Trace
Max 1
To uniquely identify a transaction to an application
The TRN segment is used to identify trace numbers that provide an electronic link between this transaction and other transactions.
2100 Loop
Repeat >1
0300
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
The NM1 segment is used to identify individuals and entities related to the hierarchical level identified by HL03.
0400
Additional Name Information
Max >1
To specify additional names
0500
Administrative Communications Contact
Max >1
To identify a person or office to whom administrative communications should be directed
0600
Demographic Information
Max 1
To supply demographic information
0700
Monetary Amount
Max 20
To indicate the total monetary amount
0800
Activity or Process Information
Max >1
To provide information on activity or process
0900
Degree Record
Max 9
To provide the receiving institution or agency notice of academic awards made to the student whose record is being transmitted
1000
Additional Individual Demographic Information
Max 1
To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student
1100
Language Use
Max 9
To specify language, type of usage, and proficiency or fluency
1200
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
1300
Text
Max >1
To specify textual data
1400
Quantity
Max 99
To specify quantity information
1500
Work Schedule
Max 99
To specify an individual's work schedule
1600
Conditions Indicator
Max 9
To supply information on conditions
1700
Health Care Services Delivery
Max 99
To specify the delivery pattern of health care services
1800
Basic Claim Information
Max 9
To identify information basic to the processing of any claims transaction
1900
Practice Detail Information
Max 1
To provide detail information on a health care provider's practice
2000
Hospital Affiliation Detail
Max 1
To provide detail information describing a provider's affiliation to a specific hospital
2110 Loop
Repeat >1
2100
Property or Entity Identification
Max 1
To define the attributes of a property or an entity
Loop 2110 provides multiple addresses related to the entity identified in the NM1 segment. The NX1 segment provides the type of address for each iteration of the loop. For instance, billing service or place of business.
2200
Additional Name Information
Max 1
To specify additional names
2300
Address Information
Max 2
To specify the location of the named party
2400
Geographic Location
Max 1
To specify the geographic place of the named party
2500
Administrative Communications Contact
Max 1
To identify a person or office to whom administrative communications should be directed
2120 Loop
Repeat >1
2600
Industry Code
Max 1
Code to transmit standard industry codes
2700
Name
Max 2
To identify a party by type of organization, name, and code
2800
Business Professional Title
Max >1
To identify title of an individual within a company
2900
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
3000
Quantity
Max 1
To specify quantity information
3100
Yes/No Question
Max >1
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
2130 Loop
Repeat 99
3200
Health Care Provider License
Max 1
To provide license, certification, accreditation, and registration information for health care providers
3300
Date or Time or Period
Max >1
To specify any or all of a date, a time, or a time period
2140 Loop
Repeat >1
3400
Reference Identification
Max 1
To specify identifying information
3500
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
2150 Loop
Repeat 9
3600
Employment Position
Max 1
To describe employment position
3700
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
3800
Transaction Set TrailerMandatory
Max 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)
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.