Interoperability

administrative standard

X12: X12 Insurance and Administrative Transactions

Select payer-approved transaction versions and implementation guides before eligibility, claim, remittance, status, or authorization exchange.

Statuslicense-review-required
StewardX12
Profiles5
Linked contracts1

Versions and profiles

Deployment scope must be selected and verified before live exchange.

01270/271 eligibility
02276/277 claim status
03278 services review
04837 claims
05835 remittance
Capabilities

Approved exchange scope

  • eligibility
  • claim status
  • prior authorization transactions
  • claims
  • remittance advice
Evidence

Required conformance artifacts

  • licensed implementation guide
  • trading-partner agreement
  • synthetic transaction tests
  • acknowledgement validation
Controls

Required before live use

  • payer-specific validation
  • trading-partner approval
  • financial audit trace
  • no final reimbursement decision
  • human exception review

Contract bindings

Connector contracts using this standard.

Primary sources

Official references retained for implementation review.