Eligibility/Benefit Inquiry and Information Response (/), its related .. The implementation guides for X12N and all other HIPAA standard transactions are available .. technical report type 3 documents and code sets. . by calling toll-free at option 2, 0, and then 3. / Eligibility Benefit Inquiry and Response Companion Guide- HIPAA version Version .. The ANSI X12N TR3s and Erratas adhere to the final HIPAA Transaction Regulations and have been are available electronically at Free Standing Prescription Drug. Medicaid / HIPAA Companion Guide .. the ANSI X12 and transactions may be found at or can Free-Form Message Text.

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Companion Guides

Payment made in full. Is patient confined to room? Subscriber and policyholder name mismatched. Number of miles patient was transported. Round trip purpose description.

HIPAA and EDI – AvMed

Entity’s Blue Cross provider id. Entity’s health insurance claim number HICN. Eligibility for extended benefits. Entity is not selected primary care provider. Most recent pacemaker battery change date. This is a final request for information.


Provider Accept Assignment Code Start: Narrative with pocket depth chart. Entity’s anesthesia giide number.

To be used for Property and Casualty gyide. Information was requested by a non-electronic method. Entity’s plan network id.

Hospice Employee Indicator Start: Federal sequestration adjustment Start: Purchase price for the rented durable medical equipment. Submitter not approved for electronic claim submissions on behalf of this entity. Use status code 21 and status code Start: Purchase and rental price of durable hilaa equipment. Entity’s relationship to patient. One calendar year per claim. Date of most recent medical event necessitating service s Start: Waiting for final approval.

For Providers

Entity was unable to respond within the expected time frame. Filter Codes by Status: Procedure code not valid for patient age Start: Cannot process individual insurance policy claims. More information available than can be returned in real-time mode.

Entity’s employer name, address and phone. Maximum leave days exhausted Start: Dental service narrative needed.

Necessity for concurrent care more than one physician treating the patient Start: Hospital late charges Start: Revenue code for services rendered. See STC12 for details. Minutes from previous meetings can be found in the FAQs. A detailed explanation is required in STC12 when this code is used. Oxygen contents for hipaaa system rental.


The greatest level of diagnosis code specificity is required. Is service performed for a recurring condition or new condition? Loaded miles and charges for transport to nearest facility with appropriate services Start: Claim will continue processing in a batch mode. Originator Application Transaction Identifier Start: Obstetric Additional Units Start: Entity’s name, address, phone and id number.

Predetermination is on file, awaiting completion of services. Missing or invalid lab indicator Start: Can patient operate controls of bed? Peer Review Authorization Number Start: Claim Adjustment Indicator Start: Information was requested by an electronic method. Claim requires signature-on-file indicator.

Is there a release of information signature on file?