Sample EDI 274 Data for the Healthcare Provider Information Transaction Set


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI274PWHealthcare Provider Information InsuranceDownload


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Research and Development:
Below is a sample EDI 274 transaction set. The Jobisez.com site has an online translation tool that converts the EDI 274 (Healthcare Provider Information) document into a CSV file. If you are researching the 274s, you can view other trading partner's mapping specifications. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

Solutions:
Are you looking to trade the EDI 274 transaction with one of your trading partners? Do you need an EDI VAN Savings solution to exchange the 274? Or perhaps you would like to use a Cloud-Based application, so you can plug your 274 transaction directly into your ERP and TMS systems. Even small companies have the ability to trade the EDI 274 by using the EDI Mobile Device solution.

Sample of an EDI 274 Transaction Set

ST*274*0171*004050X109
BHT*0028*27*20180208113701072*20180208*113701
DTM*507*20180208
PER*BJ*Jim Lyons*TE*8314305500
HL*1**20*1
NM1*ACV*2*Central California Alliance for Health*****FI*770395311
NM1*NN*2*Central California Alliance for Health
HL*2*1*21*1
NM1*40*2*DHCS Managed Care
HL*3*2*4*1
NM1*QV*2*Stars Therapy Services
N2*473903605
DTP*092*D8*20150915
HL*4*3*N*1
NM1*77*2*Starts Therapy Services*****XX*1578940839
N2*473903605;10;;27;;;;0;;;N*;;;;;N
PER*AJ**TE*8312614088*EM*info@beaconhealthoptions.com
LUI*LE*sgn***A
DTP*092*D8*20150915
PDI**0*12
NX1*77
N3*153 Cayuga Street
N4*Salinas*CA*93901
LQ*68*305S00000X
TPB*3G
REF*N5*11417331;;
NM1*30*2*Stars Therapy Services*****EQ*473903605
HL*5*4*19*0
NM1*1P*1*Williams*Erin****XX*1033485172
N2*FIRST;100;F;19500101;N;;N;;88;002000;;N;N*1149993;OTH;CA;;CA;AJ1D;1033485172
N2*EMAIL;info@beaconhealthoptions.com
LUI*LE*sgn***A
DTP*092*D8*20150915
LQ*68*235Z00000X
REF*N5*;1;1149993
HL*6*4*19*0
NM1*1P*1*LodoliniKho*Ann****XX*1235508417
N2*FIRST;100;F;19500101;N;;N;;88;002000;;N;N*11417331;OTH;CA;;CA;1D;1235508417
N2*EMAIL;info@beaconhealthoptions.com
LUI*LE*sgn***A
DTP*092*D8*20151115
LQ*68*103K00000X
REF*N5*;1;11417331
HL*7*4*19*0
NM1*1P*1*Palmer*David****XX*1528425469
N2*FIRST;100;M;19500101;N;;N;;88;002000;;N;N*11521261;OTH;CA;;CA;1D;1528425469
N2*EMAIL;aaron@santacruzaba.com
LUI*LE*sgn***A
DTP*092*D8*20160815
LQ*68*103K00000X
REF*N5*;1;11521261
HL*8*2*4*1
NM1*QV*2*The Village Project Inc
N2*611562515
DTP*092*D8*20151015
HL*9*8*N*1
NM1*77*2*The Village Project Inc*****XX*1073758249
N2*611562515;10;;27;;;;0;;;N*;;;;;N
PER*AJ**TE*8313921500*EM*mel@villageprojectinc.org
DTP*092*D8*20151015
PDI**0*99
NX1*77
N3*1069 Broadway Avenue*Suite 201
N4*Seaside*CA*93955
LQ*68*251S00000X
TPB*3G
REF*N5*20974;;
NM1*30*2*The Village Project Inc*****EQ*611562515
HL*10*9*19*0
NM1*1P*1*Battle*Regina****XX*1508154469
N2*FIRST;100;F;19500101;N;;N;;88;002000;;N;N*67681;MFT;CA;;CAG;1DAJ;1508154469
N2*EMAIL;reginab@villageprojectinc.org
DTP*092*D8*20170115
LQ*68*101YP2500X
REF*N5*;1;67681
HL*11*9*19*0
NM1*1P*1*Mason*Melvin****XX*1548438419
N2*FIRST;100;M;19500101;N;;N;;88;002000;;Y;N*20974;CSW;CA;;CAG;ADSGPDIC1D;1548438419
N2*EMAIL;mel@villageprojectinc.org
DTP*092*D8*20151015
LQ*68*1041C0700X
REF*N5*;1;20974
HL*12*2*4*1
NM1*QV*2*ARETE PHARMACY NETWORK
N2*860318370
DTP*092*D8*20061101
HL*13*12*N*0
NM1*77*2*ROMIE LANE PHARMACY INC*****XX*1558456988
N2*860318370;3P;;27;;;;0;;;N*;;;;;N
PER*AJ**TE*8314240395*EM*ROSTARELLO@GMAIL.COM
DTP*092*D8*19000101
NX1*77
N3*505 E ROMIE LN*STE H
N4*SALINAS*CA*93901
LQ*68*333600000X
REF*N5*PHY45642;;
NM1*30*2*ARETE PHARMACY NETWORK*****EQ*860318370
HL*14*2*4*1
NM1*QV*2*ACCESS IV INC
N2*020653265



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