Healthcare EDI
HIPAA-mandated transactions for eligibility, claims, prior authorization, and remittance between providers and payers.
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270healthcare
Eligibility, Coverage or Benefit Inquiry
The HIPAA X12 270 is a request from a healthcare provider to a payer asking whether a patient has active insurance coverage and what benefits apply.
271healthcare
Eligibility, Coverage or Benefit Information
The HIPAA X12 271 is the payer's response to a 270 inquiry, detailing whether the patient is covered and describing plan benefits, copays, and limitations.
837healthcare
Health Care Claim
The HIPAA X12 837 is the electronic claim a provider submits to a payer to request payment for services rendered (professional, institutional, or dental).
835healthcare
Health Care Claim Payment/Advice
The HIPAA X12 835 explains how a payer adjudicated a claim — what was paid, denied, or adjusted, and why — while optionally carrying the actual payment.