ANSI X12

X12 An ANSI-accredited group that defines EDI standards for many American industries, including health care insurance. Most of the electronic transaction standards mandated or proposed under HIPAA are X12 standards.

The ANSI X12 formats are messaging standards developed for the sole purpose of transmitting data between two entities referred to as trading partners in the HIPAA legislation. The organization of each ANSI ASC X12 standard is determined by well-defined business needs. Specific uses of each standard are defined in implementation guides.

Important ANSI ASC X12 Syntax Concepts
 Data in ANSI ASC X12 standards is organized into segments. Each segment contains multiple data elements, which are classified as simple or composite. Data elements may contain coded information maintained by ANSI ASC X12 (Internal code lists) or by outside organizations (External code lists) as well as qualified information.

 Multiple occurrences of information is supported by the looping structure in the 837 claim/encounter standard. Parent/Child relationships between loops is also supported in the 837 standards by use of Hierarchical Levels (HL segments).

 Segments and data elements in each loop are defined as either required or situational in each implementation guide. A statement of the usage of each situational data element is defined in the implementation guide.

Following are some ANSI X12 transactions used in the industry:

X12 148 The X12 First Report of Injury, Illness, or Incident transaction. This standard could eventually be included in the HIPAA mandate.

X12 270 The X12 Health Care Eligibility & Benefit Inquiry transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 271 The X12 Health Care Eligibility & Benefit Response transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 274 The X12 Provider Information transaction.

X12 275 The X12 Patient Information transaction. This transaction is expected to be part of the HIPAA claim attachments standard.

X12 276 The X12 Health Care Claims Status Inquiry transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 277 The X12 Health Care Claim Status Response transaction. Version 4010 of this transaction has been included in the HIPAA mandates. This transaction is also expected to be part of the HIPAA claim attachments standard.

X12 278 The X12 Referral Certification and Authorization transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 811 The X12 Consolidated Service Invoice & Statement transaction.

X12 820 The X12 Payment Order & Remittance Advice transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 831 The X12 Application Control Totals transaction.

X12 834 The X12 Benefit Enrollment & Maintenance transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 835 The X12 Health Care Claim Payment & Remittance Advice transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 837 The X12 Health Care Claim or Encounter transaction. This transaction can be used for institutional, professional, dental, or drug claims. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 997 The X12 Functional Acknowledgement transaction. View blog reactions