270 Health Care Eligibility Benefit Inquiry

Send a Health Care Eligibility Inquiry, also known as 270 to the trading partner (generally an insurance company) to determine whether a patient is eligible for certain claim benefits.

271 Health Care Eligibility Benefit Response

Send a Health Care Eligibility Response, also known as 271, response to the trading partner stating the patient's eligibility. The response document contains details such as eligibility status, maximum benefits, in-plan/out of plan benefits, and co-payments.

276 Health Care Claim Status Request

Send a Health Care Claim Status Request, also known as 276, to request the current status of a specified claim.

277 Health Care Claim Status Response

Send a Health Care Claim Status Response, also known as 277, to the requestor with the current status of the adjudication process. If the request matches more than one claim in the payer's system, the response may include multiple claims.

278 Health Care Services Request for Review and Response

Send a Health Care Services Request for Review and Response, also known as 278, to health care provider, payers, delegated UMO entities, and other providers.

820 Payroll Deducted and Other Group Premium Payment for Insurance Products

Send a Payroll Deducted and Other Group Premium Payment for Insurance Products, also known as 820, to initiate a payment with the remittance detail needed by the premium receiver, or without the remittance detail and send the remittance detail separately to the premium receiver.

834 Benefit Enrollment and Maintenance

Send a Benefit Enrollment and Maintenance Request, also known as 834, to transfer enrollment information from the sponsor to a payer.

835 Health Care Claim Payment/Advice

Send a Health Care Claim Payment/Advice, also known as 835, to make a payment, send an Explanation of Benefits (EOB) remittance advice, or make a payment and send an EOB remittance advice from a health care payer to a health care provider, either directly or through a Depository Financial Institution (DFI).

837 Health Care Claims fall into three categories: Professional, Institutional, and Dental.Module for HIPAA supports all three categories

837 Health Care Claim Professional

Send a Health Care Claim Professional, also known as 837, to the trading partner (generally an insurance company) to submit health care claim billing information, encounter information, or both, from providers of health care services.

837 Health Care Claim Institutional

Send a Health Care Claim Institutional, also known as 837, to the trading partner (generally an insurance company) to submit health care claim billing information, encounter information, or both, from providers of health care services.

837 Health Care Claim Dental

Send a Health Care Claim Dental, also known as 837, to the trading partner (generally an insurance company) to submit health care claim billing information, encounter information, or both, from providers of health care services.