269 Health Care Benefit Coordination Verification
269 Health Care Benefit Coordination Verification
Function Group HV
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 Health Care Benefit coordination information such as claim identification and previous payment from one Health Care Payer to another and report the positive or negative acknowledgment of payments.
Position
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
1000Loop
Mandatory
Repeat 2
0300
NameMandatory
Max 1
To identify a party by type of organization, name, and code
0400
Additional Name InformationOptional
Max 1
To specify additional names
0500
Address InformationOptional
Max 1
To specify the location of the named party
0600
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0700
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
Position
Segment
Name
Max Use
2000Loop
Mandatory
Repeat >1
0100
TraceMandatory
Max 1
To uniquely identify a transaction to an application
0200
Claim Level DataOptional
Max 1
To supply information common to all services of a claim
0300
Date or Time or PeriodOptional
Max 1
To specify any or all of a date, a time, or a time period
0400
Request ValidationOptional
Max 1
To specify the validity of the request and indicate follow-up action authorized
2100Loop
Optional
Repeat 4
0500
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
0600
Additional Name InformationOptional
Max 1
To specify additional names
0700
Address InformationOptional
Max 1
To specify the location of the named party
0800
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0900
Reference IdentificationOptional
Max 9
To specify identifying information
1000
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
1100
Date or Time or PeriodOptional
Max 1
To specify any or all of a date, a time, or a time period
2200Loop
Optional
Repeat 999
1200
Service InformationMandatory
Max 1
To supply payment and control information to a provider for a particular service
1300
Date or Time or PeriodOptional
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)