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Military Health System

Table of HIPAA Adopted Transactions Used by MHS

Transaction Standard
Eligibility for a health plan (request and response)—Dental, professional, and institutional X12N 270/271
Eligibility for a health plan (request and response)—Retail pharmacy drugs NCPDP D.0
Enrollment and disenrollment in a health plan X12N 834
Referral certification and authorization (request and response)—Dental, professional, and institutional X12N 278
Referral certification and authorization (request and response)—Retail pharmacy drugs NCPDP D.0
Health care claims or equivalent encounter information—Dental X12N 837D
Health care claims or equivalent encounter information—Professional X12N 837P
Health care claims or equivalent encounter information—Institutional X12N 837I
Health care claims or equivalent encounter information—Retail pharmacy NCPDP D.0
Health care claims or equivalent encounter information—Retail pharmacy supplies and professional services X12N 837P and NCPDP  D.0
Health care claim status (request and response) X12N 276/277
Coordination of Benefits - Retail pharmacy drugs NCPDP D.0
Coordination of Benefits - Dental X12N 837D
Coordination of Benefits - Professional X12N 837P
Coordination of Benefits - Institutional X12N 837I
Health care payment and remittance advice X12N 835
Health care electronic funds transfers (EFT) and health care payment and remittance advice (RA) NACHA CCD+ and X12N 835 TRN Segment

Note: Transactions in this table are listed in their business process sequence.

Last Updated: March 07, 2017
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