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Back   Health Care Benefit Coordination Verification Request and Response (004040X122)

Purpose

The Health Care Benefit Coordination Verification Request and Response Implementation Guide describes the use of the ANSI ASC X12 Health Benefit Coordination Verification Request and Response (269) transaction set for the following business usage:
  • For any payer to request that a more primary payer verify it paid benefits as reported for the more primary payer to respond

Primary Trading Partners

Trading partners include:
  • Health Care payers coordinating benefits for a claim when no paper remittance is available

Exceptions/Limitations

This is not a way to ask what benefits were paid (benefits are reported in the request for verification and confirmed or denied in the response). This is not used to request eligibility or to file a secondary claim.

References

This is the first implementation guide for this business purpose.

Additional Information

Registered 2/10/1999 Published 5/1/2003
Transaction Set ID 269 Standard Version 004040
ASC X12 DM# Owning Group X12N/TG2/WG3