| Transaction | Number | Business use |
| Claim/encounter | X12 837 | For submitting claim to health plan, insurer, or other payer |
| Eligibility inquiry and response | X12 270 and 271 | For inquiring of a health plan the status of a patient.s eligibility for benefits and details regarding the types of services covered, and for receiving information in response from the health plan or payer. |
| Claim status inquiry and response | X12 276 and 277 | For inquiring about and monitoring outstanding claims (where is the claim? Why haven.t you paid us?) and for receiving information in response from the health plan or payer. Claims status codes are now standardized for all payers. |
| Referrals and prior authorizations | X12 278 | For obtaining referrals and authorizations accurately and quickly, and for receiving prior authorization responses from the payer or utilization management organization (UMO) used by a payer. |
| Health care payment and remittance advice | X12 835 | For replacing paper EOB/EOPs and explaining all adjustment data from payers. Also, permits auto-posting of payments to accounts receivable system. |
| Health claims attachments (proposed) | X12 275 | For sending detailed clinical information in support of claims, in response to payment denials, and other similar uses. |
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