Transactions Overview
Transactions Overview
What Is a Transaction?
A transaction is an electronic exchange of information between two parties to carry out financial or administrative activities related to health care. For example, a health care provider will send a claim to a health plan to request payment for medical services.
Health Care Transactions Basics (PDF)
Overview document of electronic transactions used in health care to increase efficiencies in operations, improve the quality and accuracy of information, and reduce the overall costs to the system.
Standards for Transactions
Under HIPAA, HHS adopted certain standard transactions for the electronic exchange of health care data. These transactions include:
HIPAA covered entities who conduct any of these transactions electronically must use an adopted standard from ASC X12N or NCPDP (for certain pharmacy transactions).
Violations
You can submit complaints about potential transaction standard violations via the Administrative Simplification Enforcement and Testing Tool (ASETT). Learn how to file a complaint.
Download our Compliance Review Supplemental Resources zip file (ZIP) to learn about common violations.
Exceptions
An organization may request an exception from the use of a standard transaction from the Secretary to test a proposed modification to that standard. Learn about our exceptions process and the principles for requesting an exception (PDF).
Learn More
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Downloads
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Eligibility and Benefits Transaction (PDF) -
Coordination of Benefits Transactions (PDF) -
Claim Status Transactions Basics (PDF) -
Health Plan Eligibility and Benefits Transaction Basics (PDF) -
EFT and ERA: Payment Remittance Reassociation Basics (PDF) -
Electronic Funds Transfer and Electronic Remittance Advice Transactions (PDF) -
Administrative Simplification Resources Toolkit (ZIP)
Page Last Modified:
12/18/2024 10:31 PM