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.
To indicate the start of a transaction set and to assign a control number
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
To specify pertinent dates and times
To identify a person or office to whom administrative communications should be directed
To identify dependencies among and the content of hierarchically related groups of data segments
To uniquely identify a transaction to an application
To supply the full name of an individual or organizational entity
To specify additional names
To identify a person or office to whom administrative communications should be directed
To supply demographic information
To indicate the total monetary amount
To provide information on activity or process
To provide the receiving institution or agency notice of academic awards made to the student whose record is being transmitted
To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student
To specify language, type of usage, and proficiency or fluency
To specify any or all of a date, a time, or a time period
To specify textual data
To specify quantity information
To specify an individual's work schedule
To supply information on conditions
To specify the delivery pattern of health care services
To identify information basic to the processing of any claims transaction
To provide detail information on a health care provider's practice
To provide detail information describing a provider's affiliation to a specific hospital
To define the attributes of a property or an entity
To specify additional names
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
Code to transmit standard industry codes
To identify a party by type of organization, name, and code
To identify title of an individual within a company
To specify any or all of a date, a time, or a time period
To specify quantity information
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
To provide license, certification, accreditation, and registration information for health care providers
To specify any or all of a date, a time, or a time period
To specify identifying information
To specify any or all of a date, a time, or a time period
To describe employment position
To specify any or all of a date, a time, or a time period
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
