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X12N
transaction standard
American National
Standards Institute (ANSI) Accredited Standards Committee
(ASC) X12 transactions are part of the Transactions
and Code Sets Rule selected by HIPAA. (ANSI X12 subcommittee
N covers standards in the insurance industry, including health
insurance; hence these are X12N standards.)
X12N standards
include transactions for claims/encounters, attachments, enrollment,
disenrollment, eligibility, payment/remittance advice, premium
payments, first report of injury, claim status, referral certification/authorization,
and coordination of benefits. By name and number, they include:
- X12N 837 - Health
Care Claim, Dental
- X12N 837 - Health
Care Claim, Professional
- X12N 837 - Health
Care Claim, Institutional
- X12N 835 - Health
Care Claim Payment/Advice
- X12N 834 - Benefit
Enrollment and Maintenance
- X12N 820 - Payroll
Deducted and Other Group Premium Payment for Insurance Products
- X12N 278 - Health
Care Services Request for Review and Response
- X12N 276 - Health
Care Claim Status Request
- X12N 277 - Health
Care Claim Status Response
- X12N 270 - Health
Care Claim Eligibility Inquiry
- X12N 271 - Health
Care Claim Eligibility Response
- X12N 148 - Report
of Injury or Illness
- X12N 186 - Life
and Annuity Lab Report
- X12N 275 - Patient
Information
Within these standard
transactions, the code set standard for diagnoses are those
of the International Classification
of Diseases - Clinical Modification (ICD-CM); procedures
are categorized using Current Procedural
Terminology (CPT) codes, Healthcare
Common Procedure Coding System (HCPCS) or, for dental
procedures, the Code on Dentral
Procedures and Nomenclature (CDT).
Pharmacy transactions
can use the National Council
of Prescription Drug Programs (NCPDP) transaction format.,
and within that NDC codes or HCPCS.
See also:
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