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HIPAA: Overview - Standardized Transactions

Today, health care providers and plans use many different electronic formats for electronic transactions. Under HIPAA, the standards for electronic transactions final rule adopts eight electronic transactions and code set standards. Medi-Cal accepts these standards for professional, institutional, and dental claims. The new electronic transaction standards required by HIPAA impact Electronic Data Interchange (EDI) only, and are accredited by the American National Standards Institute (ANSI).

The electronic claim format requirements impact the data that you must submit in order for your claim to be processed. Below is a list of the eight transactions and their corresponding numbers.

ANSI ASC X12N
Standard Transactions
Version
Health Care Eligibility Benefit Inquiry and Response – 270/271 005010X279A1
Health Care Claim Status Request and Response – 276/277 005010X212
Health Care Services Review – 278 005010X216
Health Care Claim Payment/Advice – 835 005010X221A1
Health Care Claims and Encounters – 837 - Professional 005010X222A1
- Institutional 005010X223A1
- Dental 0055010X224A1
NCPDP Standard Transactions
Telecommunication D.0
Batch 1.2