| 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.
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Last Updated: July 11, 2023