EDI 274 Healthcare Provider Information

This X12 Transaction Set 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. Such exchanges include the transmitting, inquirying, or responding to an inquiry. Healthcare provider information is routinely exchanged for the purpose of 1) maintaining provider data bases for claim adjudication, provider directories, patient referrals, and reporting provider information, 2) submitting an application to join a provider organization or provider network such as, but not limited to, 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.

Segments

Position
Segment
Name
Max use
100
ST
Transaction Set Header
Mandatory
AtMax 1
To indicate the start of a transaction set and to assign a control number
200
BHT
Beginning of Hierarchical Transaction
Mandatory
AtMax 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
300
DTM
Date/Time Reference
Opt
AtMax 1
To specify pertinent dates and times
400
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
2120
LOOP
Opt
GT 1
2130
LOOP
Opt
AtMax 99
2140
LOOP
Opt
GT 1
2150
LOOP
Opt
AtMax 9
2160
LOOP
Opt
GT 1
3800
SE
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

PositionElementNameRequirementTypeMin/MaxRepeat
1
143
Transaction Set Identifier CodeMandatoryID3/31
2
329
Transaction Set Control NumberMandatoryAlphanumeric4/91
3
1705
Implementation Convention ReferenceOptAlphanumeric1/351