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HITSP/T40
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July 8, 2009

Version 1.3

HITSP Patient Health Plan Eligibility Verification Transaction

HITSP/T40   Click here to download the PDF version of this document

Healthcare Information Technology Standards Panel (HITSP) logo

Submitted to:

Healthcare Information Technology Standards Panel

Submitted by:

Administrative and Financial Domain Technical Committee

Document Change History

Version Number

Description of Change

Name of Author

Date Published

0.0.1

Review Copy

Care Delivery Technical Committee

December 7, 2007

0.0.2

Review Copy

Care Delivery Technical Committee

March 19, 2008

1.0

Released for Implementation

Care Delivery Technical Committee

March 27, 2008

Template Updated to V2.4

Project Team

July 31, 2008

1.0.1

Review Copy

Administrative and Financial Domain Technical Committee

August 20, 2008

1.1

Released for Implementation

Administrative and Financial Domain Technical Committee

August 27, 2008

1.1.1

Review Copy

Administrative and Financial Domain Technical Committee

September 26, 2008

1.1.2

Review Copy

Administrative and Financial Domain Technical Committee

December 10, 2008

1.2

Released for Implementation

Administrative and Financial Domain Technical Committee

December 18, 2008

Template V2.5

Project Team

June 30, 2009

1.2.1

Review Copy

Administrative and Financial Domain Technical Committee

June 30, 2009

1.3

Released for Implementation

Administrative and Financial Domain Technical Committee

July 8, 2009

Table of Contents

1.0 Introduction. 5

1.1 Overview. 5

1.2 Copyright Permissions. 5

1.3 Reference Documents. 5

1.4 Conformance. 5

1.4.1 Conformance Criteria. 6

1.4.2 Conformance Scoping, Subsetting and Options. 6

2.0 Transaction Definition. 7

2.1 Context Overview. 7

2.1.1 Transaction Constraints. 7

2.1.2 Interfaces. 8

2.1.3 Interface Interactions. 8

2.1.4 Pre-conditions. 9

2.1.4.1 Process Triggers. 9

2.1.5 Post-conditions. 9

2.1.5.1 Required Outputs. 9

2.1.6 Data Flows. 9

2.2 List of HITSP Constructs. 15

2.2.1 Construct Dependencies. 15

2.2.2 Additional Constraints on Required Constructs. 15

2.3 Standards. 15

2.3.1 Regulatory Guidance. 15

2.3.2 Selected Standards. 15

2.3.3 Informative Reference Standards. 16

3.0 Appendix. 17

4.0 DOCUMENT UPDATES. 18

4.1 December 7, 2007. 18

4.2 March 19, 2008. 18

4.3 March 27, 2008. 18

4.4 August 20, 2008. 18

4.5 August 29, 2008. 18

4.6 December 10, 2008. 19

4.7 December 18, 2008. 19

4.8 June 30, 2009. 19

4.9 July 8, 2009. 19

Figures and Tables

Figure 2-1 Eligibility Verification Flow Diagram.. 8

Table 1-1 Reference Documents. 5

Table 2-1 Transaction Constraints. 7

Table 2-2 Interfaces. 8

Table 2-3 Pre-conditions. 9

Table 2-4 Process Triggers. 9

Table 2-5 Post-conditions. 9

Table 2-6 Required Outputs. 9

Table 2-7 X12N 270/271 Data Mapping. 11

Table 2-8 List of HITSP Constructs. 15

Table 2-9 Construct Dependencies. 15

Table 2-10 Additional Constraints on Required Constructs. 15

Table 2-11 Regulatory Guidance. 15

Table 2-12 Selected Standards. 15

Table 2-13 Informative Reference Standards. 16

Healthcare Information Technology Standards Panel (HITSP) logo Return to detail page at www.hitsp.org

HITSP/T40
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