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Glossary

Glossary

This glossary explains terms found on the cms.hhs.gov web site, but it is not a legal document.

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X

Term Definition
X12

An ANSI-accredited group that defines EDI standards for many American industries, including health care insurance. Most of the electronic transaction standards mandated or proposed under HIPAA are X12 standards.

X12 148

The X12 First Report of Injury, Illness, or Incident transaction. This standard could eventually be included in the HIPAA mandate.

X12 270

The X12 Health Care Eligibility & Benefit Inquiry transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 271

The X12 Health Care Eligibility & Benefit Response transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 274

The X12 Provider Information transaction.

X12 275

The X12 Patient Information transaction. This transaction is expected to be part of the HIPAA claim attachments standard.

X12 276

The X12 Health Care Claims Status Inquiry transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 277

The X12 Health Care Claim Status Response transaction. Version 4010 of this transaction has been included in the HIPAA mandates. This transaction is also expected to be part of the HIPAA claim attachments standard.

X12 278

The X12 Referral Certification and Authorization transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 811

The X12 Consolidated Service Invoice & Statement transaction.

X12 820

The X12 Payment Order & Remittance Advice transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 831

The X12 Application Control Totals transaction.

X12 834

The X12 Benefit Enrollment & Maintenance transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 835

The X12 Health Care Claim Payment & Remittance Advice transaction. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 837

The X12 Health Care Claim or Encounter transaction. This transaction can be used for institutional, professional, dental, or drug claims. Version 4010 of this transaction has been included in the HIPAA mandates.

X12 997

The X12 Functional Acknowledgement transaction.

X12 IHCEBI & IHCEBR

The X12 Interactive Healthcare Eligibility & Benefits Inquiry (IHCEBI) and Response (IHCEBR) transactions. These are being combined and converted to UN/EDIFACT Version 5 syntax.

X12 IHCLME

The X12 Interactive Healthcare Claim transaction.

X12 STANDARD

The term currently used for any X12 standard that has been approved since the most recent release of X12 American National Standards. Since a full set of X12 American National Standards is only released about once every five years, it is the X12 standards that are most likely to be in active use. These standards were previously called Draft Standards for Trial Use.

X12/PRB

The X12 Procedures Review Board.

X12F

A subcommittee of X12 that defines EDI standards for the financial industry. This group maintains the X12 811 [generic] Invoice and the X12 820 [generic] Payment & Remittance Advice transactions, although X12N maintains the associated HIPAA Implementation guides.

X12J

A subcommittee of X12 that reviews X12 work products for compliance with the X12 design rules.

X12N

A subcommittee of X12 that defines EDI standards for the insurance industry, including health care insurance.

X12N/SPTG4

The HIPAA Liaison Special Task Group of the Insurance Subcommittee (N) of X12. This group's responsibilities have been assumed by X12N/TG3/WG3.

X12N/TG1

The Property & Casualty Task Group (TG1) of the Insurance Subcommittee (N) of X12.

X12N/TG2

The Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12.

X12N/TG2/WG1

The Health Care Eligibility Work Group (WG1) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the X12 270 Health Care Eligibility & Benefit Inquiry and the X12 271 Health Care Eligibility & Benefit Response transactions, and is also responsible for maintaining the IHCEBI and IHCEBR transactions.

X12N/TG2/WG10

The Health Care Services Review Work Group (WG10) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the X12 278 Referral Certification and Authorization transaction.

X12N/TG2/WG12

The Interactive Health Care Claims Work Group (WG12) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the IHCLME Interactive Claims transaction.

X12N/TG2/WG15

The Health Care Provider Information Work Group (WG15) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the X12 274 Provider Information transaction.

X12N/TG2/WG19

The Health Care Implementation Coordination Work Group (WG19) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This is now X12N/TG3/WG3.

X12N/TG2/WG2

The Health Care Claims Work Group (WG2) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the X12 837 Health Care Claim or Encounter transaction.

X12N/TG2/WG3

The Health Care Claim Payments Work Group (WG3) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the X12 835 Health Care Claim Payment & Remittance Advice transaction.

X12N/TG2/WG4

The Health Care Enrollments Work Group (WG4) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the X12 834 Benefit Enrollment & Maintenance transaction.

X12N/TG2/WG5

The Health Care Claims Status Work Group (WG5) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the X12 276 Health Care Claims Status Inquiry and the X12 277 Health Care Claim Status Response transactions.

X12N/TG2/WG9

The Health Care Patient Information Work Group (WG9) of the Health Care Task Group (TG2) of the Insurance Subcommittee (N) of X12. This group maintains the X12 275 Patient Information transaction.

X12N/TG3

The Business Transaction Coordination and Modeling Task Group (TG3) of the Insurance Subcommittee (N) of X12. TG3 maintains the X12N Business and Data Models and the HIPAA Data Dictionary. This was formerly X12N/TG2/WG11.

X12N/TG3/WG1

The Property & Casualty Work Group (WG1) of the Business Transaction Coordination and Modeling Task Group (TG3) of the Insurance Subcommittee (N) of X12.

X12N/TG3/WG2

The Healthcare Business & Information Modeling Work Group (WG2) of the Business Transaction Coordination and Modeling Task Group (TG3) of the Insurance Subcommittee (N) of X12.

X12N/TG3/WG3

The HIPAA Implementation Coordination Work Group (WG3) of the Business Transaction Coordination and Modeling Task Group (TG3) of the Insurance Subcommittee (N) of X12. This was formerly X12N/TG2/WG19 and X12N/SPTG4.

X12N/TG3/WG4

The Object-Oriented Modeling and XML Liaison Work Group (WG4) of the Business Transaction Coordination and Modeling Task Group (TG3) of the Insurance Subcommittee (N) of X12.

X12N/TG4

The Implementation Guide Task Group (TG4) of the Insurance Subcommittee (N) of X12. This group supports the development and maintenance of X12 Implementation Guides, including the HIPAA X12 IGs.

X12N/TG8

The Architecture Task Group (TG8) of the Insurance Subcommittee (N) of X12.


*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.


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