274 - Healthcare Provider Information

FUNCTIONAL GROUP=PW

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.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BHT	Beginning of Hierarchical Transaction	0200
DTM	Date/Time Reference	0300
PER	Administrative Communications Contact	0400

2000

Segment	Name	Position
HL	Hierarchical Level	0100
TRN	Trace	0200
AAA	Request Validation	0250

2100

Segment	Name	Position
NM1	Individual or Organizational Name	0300
N2	Additional Name Information	0400
PER	Administrative Communications Contact	0500
DMG	Demographic Information	0600
AMT	Monetary Amount Information	0700
API	Activity or Process Information	0800
DEG	Degree Record	0900
IND	Additional Individual Demographic Information	1000
LUI	Language Use	1100
DTP	Date or Time or Period	1200
AAA	Request Validation	1250
MTX	Text	1300
QTY	Quantity Information	1400
WS	Work Schedule	1500
CRC	Conditions Indicator	1600
HSD	Health Care Services Delivery	1700
BCI	Basic Claim Information	1800
PDI	Practice Detail Information	1900
HAD	Hospital Affiliation Detail	2000

2110

Segment	Name	Position
NX1	Property or Entity Identification	2100
N2	Additional Name Information	2200
N3	Party Location	2300
N4	Geographic Location	2400
PER	Administrative Communications Contact	2500

2120

Segment	Name	Position
LQ	Industry Code Identification	2600
N1	Party Identification	2700
TPB	Business Professional Title	2800
DTP	Date or Time or Period	2900
QTY	Quantity Information	3000
YNQ	Yes/No Question	3100
AAA	Request Validation	3150

2130

Segment	Name	Position
HPL	Health Care Provider License	3200
DTP	Date or Time or Period	3300
AAA	Request Validation	3350

2140

Segment	Name	Position
REF	Reference Information	3400
DTP	Date or Time or Period	3500
AAA	Request Validation	3550

2150

Segment	Name	Position
EMS	Employment Position	3600
DTP	Date or Time or Period	3700
SE	Transaction Set Trailer	3800

COMMENTS

Notes
1/0400	The PER segment is used to supply the sender's point of contact to the receiver.
2/0100	Valid hierarchical level codes for this transaction set are information source, information receiver, provider, group and site of service.
2/0200	The TRN segment is used to identify trace numbers that provide an electronic link between this transaction and other transactions.
2/0300	The NM1 segment is used to identify individuals and entities related to the hierarchical level identified by HL03.
2/2100	Loop 2110 provides multiple addresses related to the entity identified in the NM1 segment. The NX1 segment provides the type of address for each iteration of the loop. For instance, billing service or place of business.

rev 02/12/2024