EDI 269 Health 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.

Segments

Position

Segment

Name

Max use

100

Transaction Set Header

Mandatory

AtMax 1

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

200

BGN

Beginning Segment

Mandatory

AtMax 1

To indicate the beginning of a transaction set

1000

LOOP

Mandatory

AtMax 2

300

Party Identification

Mandatory

AtMax 1

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

400

Additional Name Information

Opt

AtMax 1

To specify additional names

500

Party Location

Opt

AtMax 1

To specify the location of the named party

600

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

700

PER

Administrative Communications Contact

Opt

AtMax 1

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

2000

LOOP

Mandatory

GT 1

100

TRN

Trace

Mandatory

AtMax 1

To uniquely identify a transaction to an application

200

CLP

Claim Level Data

Opt

AtMax 1

To supply information common to all services of a claim

300

DTP

Date or Time or Period

Opt

AtMax 2

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

400

AAA

Request Validation

Opt

AtMax 1

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

2100

LOOP

Opt

AtMax 4

500

NM1

Individual or Organizational Name

Opt

AtMax 1

To supply the full name of an individual or organizational entity

600

Additional Name Information

Opt

AtMax 1

To specify additional names

700

Party Location

Opt

AtMax 1

To specify the location of the named party

800

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

900

REF

Reference Information

Opt

AtMax 9

To specify identifying information

1000

PER

Administrative Communications Contact

Opt

AtMax 1

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

1100

DTP

Date or Time or Period

Opt

AtMax 1

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

2200

LOOP

Opt

AtMax 999

1200

SVC

Service Information

Opt

AtMax 1

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

1300

DTP

Date or Time or Period

Opt

AtMax 1

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

1400

Transaction Set Trailer

Mandatory

AtMax 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)

Elements

Position	Element	Name	Requirement	Type	Min/Max	Repeat

1	143	Transaction Set Identifier Code	Mandatory	ID	3/3	1

2	329	Transaction Set Control Number	Mandatory	Alphanumeric	4/9	1

3	1705	Implementation Convention Reference	Opt	Alphanumeric	1/35	1

EDI Dictionary

EDI 269 Health Care Benefit Coordination Verification

Segments

Elements