administrative standard
X12: X12 Insurance and Administrative Transactions
Select payer-approved transaction versions and implementation guides before eligibility, claim, remittance, status, or authorization exchange.
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
Approved exchange scope
- eligibility
- claim status
- prior authorization transactions
- claims
- remittance advice
Required conformance artifacts
- licensed implementation guide
- trading-partner agreement
- synthetic transaction tests
- acknowledgement validation
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.
planned
Claims and Utilization Dataset
financial
Support cost, utilization, payer analytics, and population health intelligence workflows.Primary sources