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Transaction Set
in
X12 Release 008020

269 Health Care Benefit Coordination Verification

Functional Group HV

X12N Insurance Subcommittee

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.

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 SegmentMandatory
Max 1
To indicate the beginning of a transaction set
1000 Loop
Repeat 2
0300
Party IdentificationMandatory
Max 1
To identify a party by type of organization, name, and code
0400
Additional Name Information
Max 1
To specify additional names
0500
Party Location
Max 1
To specify the location of the named party
0600
Geographic Location
Max 1
To specify the geographic place of the named party
0700
Administrative Communications Contact
Max 1
To identify a person or office to whom administrative communications should be directed

Detail

Sequence
Segment
Name
Max use
2000 Loop
Repeat >1
0100
TraceMandatory
Max 1
To uniquely identify a transaction to an application
The TRN segment is used to uniquely identify and tie an inquiry to a response.
0200
Claim Level Data
Max 1
To supply information common to all services of a claim
0300
Date or Time or Period
Max 2
To specify any or all of a date, a time, or a time period
0400
Request Validation
Max 1
To specify the validity of the request and indicate follow-up action authorized
2100 Loop
Repeat 4
0500
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
0600
Additional Name Information
Max 1
To specify additional names
0700
Party Location
Max 1
To specify the location of the named party
0800
Geographic Location
Max 1
To specify the geographic place of the named party
0900
Reference Information
Max 9
To specify identifying information
1000
Administrative Communications Contact
Max 1
To identify a person or office to whom administrative communications should be directed
1100
Date or Time or Period
Max 1
To specify any or all of a date, a time, or a time period
2200 Loop
Repeat 999
1200
Service Information
Max 1
To supply payment and control information to a provider for a particular service
1300
Date or Time or Period
Max 1
To specify any or all of a date, a time, or a time period
1400
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)
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.
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.