HIPAA X12
A set of X12 transaction sets (270/271, 276/277, 278, 834, 835, 837) that covered entities are legally required to support for eligibility, claims, and remittance.
Maintained by
X12, mandated for use under HIPAA by the U.S. Department of Health and Human Services
Envelope structure
Same X12 envelope structure as commercial X12, with HIPAA-specific implementation guides (e.g., 005010X279A1)
Primary regions
United States
Transactions under HIPAA X12
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.
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.
Health Care Claim Status Request
The HIPAA X12 276 asks a payer for the current processing status of a previously submitted health care claim.
Health Care Claim Status Response
The HIPAA X12 277 is the payer's answer to a 276, reporting where a claim stands in adjudication.
Health Care Services Review – Request/Response
The HIPAA X12 278 requests prior authorization or a referral for a health care service, and carries the payer's determination.
Benefit Enrollment and Maintenance
The HIPAA X12 834 communicates enrollment, changes, and terminations of health plan coverage from an employer or sponsor to a payer.
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.
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).