Following is a list of the approved EDI version 4 ANSI X12 documents for Insurance & Healthcare transactions. You will likely only need a small subset of the documents listed to become EDI compliant with your Trading Partner
Please note that, although their are written "standards" for each EDI document, the standards are written very loosely so that the Trading Partners, themselves, can decide on the specific structure and format, although, usually one Trading Partner dictates the format to the other.
| Insurance/Health TRANSACTION SETS (INS) | |
| Document | Description |
|---|---|
| 100 | Insurance Plan Description |
| 111 | Individual Insurance Policy and Client Information |
| 112 | Property Damage Report |
| 124 | Vehicle Damage |
| 148 | Report of Injury, Illness or Incident |
| 186 | Insurance Underwriting Requirements Reporting |
| 187 | Premium Audit Request and Return |
| 252 | Insurance Producer Administration |
| 255 | Underwriting Information Services |
| 256 | Periodic Compensation |
| 267 | Individual Life, Annuity and Disability Application |
| 268 | Annuity Activity |
| 269 | Health Care Benefit Coordination Verification |
| 270 | Eligibility, Coverage or Benefit Inquiry |
| 271 | Eligibility, Coverage or Benefit Information |
| 272 | Property and Casualty Loss Notification |
| 273 | Insurance/Annuity Application Status |
| 274 | Health Care Provider Information |
| 275 | Patient Information |
| 276 | Health Care Claim Status Request |
| 277 | Health Care Claim Status Notification |
| 278 | Health Care Services Review Information |
| 362 | Cargo Insurance Advice of Shipment |
| 500 | Medical Event Reporting |
| 834 | Benefit Enrollment and Maintenance |
| 835 | Health Care Claim Payment/Advice |
| 837 | Health Care Claim |
IMPROVED BY EDI |
IMPROVED BY EDI |
View Our Hosted EDI Plans!
For more information on our cloud based EDI services, please request a quote or contact us today!