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Back   Unsolicited Health Care Eligibility/Benefit Roster (004010X040)

Purpose

The Unsolicited Health Care Eligibility/Benefit Roster Implementation Guide describes the use of the ANSI ASC X12 Eligibility, Coverage or Benefit Information (271) Version/Release 3070 transaction set for the unsolicited request for the following roster types:
  • Capitation payment detail
  • Membership list
  • Plan (coverages)
  • Group (employer)
  • Provider

Primary Trading Partners

Health care providers, such as hospitals and physicians. Health Care payers, such as insurance companies, HMOs, PPOs, and state and federal agencies.

Exceptions/Limitations

This implementation guide is not intended for use within the property & casualty industry.

References

This is the first implementation guide for this business purpose.

Coordination

ASC X12 Insurance Subcommittee's Health Care Task Group's WG4 and WG15. ASC X12N Property & Casualty Task Group's Claim Work Group (TG1/WG2) and Workers' Compensation/Disability Work Group (TG1/WG3).

Additional Information

Registered 4/27/1996 Published 3/3/2006
Transaction Set ID 271 Standard Version 004010
ASC X12 DM# Owning Group X12N/TG2/WG1