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271 x12 Cheat Sheet (DRAFT) by

271 x12 transaction set

This is a draft cheat sheet. It is a work in progress and is not finished yet.

271 x12

x12 Mandatory Segments
Envelope Structure
ISA- Interc­​hange Header - This contains inform­​ation about the sender and recipient
Interc­hange Envelope (ISA/IEA) The interc­hange envelope is the wrapper for all the data to be sent in one transm­ission. It can contain multiple functional groups. This means that transa­ctions of different types can be included in the interc­hange envelope, with each type of transa­ction stored in a separate functional group.
IEA- End of Interc­​hange - It contains inform­​ation about the number of functional groups and the interc­​hange control reference number
ST- Transa­​ction Set Header - segment of an X12 document
Transa­ction Set (ST/SE) Each transa­ction set (also called a transa­ction) contains three things: ƒ A transa­ction set header ƒ A transa­ction set trailer ƒ A single message, enveloped within the header and footer The transa­ction has a three-­digit code, a text title, and a two-letter code; for example, 997, Functional Acknow­led­gment (FA)
SE- Transa­​ction Set Trailer - segment of an X12 document. This marks the end of a transa­​ction set
GS- Functional Group Header - segment of a set of X12 documents of the same document type (trans­​action set). Here you'll find inform­​ation about the functional group, e.g. codes for the sender, recipient, and date/time of prepar­​ation
Functional Group (GS/GE) A functional group is composed of one or more transa­ction sets, all of the same type, that can be batched together in one transm­ission. The functional group is defined by the header and trailer; the Functional Group Header (GS) appears at the beginning, and the Functional Group Trailer (GE) appears at the end. Many transa­ction sets can be included in the functional group, but all transa­ctions must be of the same type
GE- Functional Group Trailer - segment of a set of X12 documents of the same transa­​ction set. It tells you the number of functional groups and the control group number. It also marks the end of a group of transa­​ction sets


General Responses Include
•eligi­bility status •Maximum benefits (policy limits) •Exclu­sions •In-pl­an/­out­-of­-plan benefits •C.O.B. inform­ation •Deduc­tible •Co-pays
Catego­rical Responses
Procedure coverage dates •Procedure coverage maximum amount(s) allowed •Deduc­tible amount(s) •Remaining deductible amount(s) •Co-in­surance amount(s) •Co-pay amount(s) •Coverage limitation percentage •Patient respon­sib­ility amount(s) •Non-c­overed amount(s)