271 Premium Payment Grace Period Notification 7030 Basics: Health Care Transaction Flow
271 Premium Payment Grace Period Notification 7030 transaction flow subjects to ASC X12 implementation rules for health care electronic transactions. Each ASC X12 implementation guide explains how to use ASC X12 transaction sets to meet a single defined business purpose.
The following diagrams depict the business functions supported by the ASC X12 health care implementation guide. The intent of these diagrams is to represent the possible exchanges between trading partners using these implementation guides. Trading partners include entities that administer part or all of a health plan, fund the plan and enroll members, and provide the health care services. At the time of publication, transactions adopted under HIPAA are bolded.
Enrollment
- Enrollment834 Benefit Enrollment and Maintenance
- Premium Payment
820 Payroll Deducted and Other Group Premium Payment (for Insurance Products)
Pre-adjudication
1. Fee Schedule
832 Health Care Fee Schedule
2. Eligibility
270 Health Care Eligibility Benefit Inquiry
271 Health Care Eligibility Benefit Information Response
3. Health Care Services Review Request
278 Health Care Services Review – Request for Review
278 Health Care Services Review – Response
275 Additional Information to Support a Health Care Services Review
4. Health Care Services Review Inquiry
278 Health Care Services Review Inquiry
278 Health Care Services Review Response
5. Health Care Services Review Notification
278 Health Care Services Review Notification
278 Health Care Services Review Acknowledgment
6. Provider Information
274 Health Care Provider Information
274 Health Care Provider Information
7. Participating Provider Roster
274 Health Care Provider Directory
Adjudication
1. Health Care Claim and Encounter plus Additional Support Information
837 Health Care Claim: Professional
837 Health Care Claim: Institutional
837 Health Care Claim: Dental
837 Health Care Service Data Reporting
275 Additional Information to Support a Health Care Claim or Encounter
277 Health Care Claim Acknowledgment
2. Health Care Claim Status
276 Health Care Claim Status Request
277 Health Care Claim Status Response
3. Health Care Claim Additional Information
277 Health Care Claim Request for Additional Information
275 Additional Information to Support a Health Care Claim or Encounter
4. Health Care Claim Pending Status
277 Health Care Claim Pending Status Information
5. Health Care Claim Payment
835 Health Care Claim Payment/Advice
6. Premium Period Grace Period Notification
271 Premium Period Grace Period Notification
Post-adjudication
1. Coordination of Benefits
837 Health Care Claim: Professional
837 Health Care Claim: Institutional
837 Health Care Claim: Dental.