Sample EDI 274 Data for the Healthcare Provider Information Transaction Set


AgencySet IDFGTransaction DescriptionSubcommittee
ANSI274PWHealthcare Provider Information Insurance


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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.

Sample of an EDI 274 Transaction Set

Element DetailsEntire Segment
ViewST*274*0171*004050X109
ViewBHT*0028*27*20180208113701072*20180208*113701
ViewDTM*507*20180208
ViewPER*BJ*Jim Lyons*TE*8314305500
ViewHL*1**20*1
ViewNM1*ACV*2*Central California Alliance for Health*****FI*770395311
ViewNM1*NN*2*Central California Alliance for Health
ViewHL*2*1*21*1
ViewNM1*40*2*DHCS Managed Care
ViewHL*3*2*4*1
ViewNM1*QV*2*Stars Therapy Services
ViewN2*473903605
ViewDTP*092*D8*20150915
ViewHL*4*3*N*1
ViewNM1*77*2*Starts Therapy Services*****XX*1578940839
ViewN2*473903605;10;;27;;;;0;;;N*;;;;;N
ViewPER*AJ**TE*8312614088*EM*info@beaconhealthoptions.com
ViewLUI*LE*sgn***A
ViewDTP*092*D8*20150915
ViewPDI**0*12
ViewNX1*77
ViewN3*153 Cayuga Street
ViewN4*Salinas*CA*93901
ViewLQ*68*305S00000X
ViewTPB*3G
ViewREF*N5*11417331;;
ViewNM1*30*2*Stars Therapy Services*****EQ*473903605
ViewHL*5*4*19*0
ViewNM1*1P*1*Williams*Erin****XX*1033485172
ViewN2*FIRST;100;F;19500101;N;;N;;88;002000;;N;N*1149993;OTH;CA;;CA;AJ1D;1033485172
ViewN2*EMAIL;info@beaconhealthoptions.com
ViewLUI*LE*sgn***A
ViewDTP*092*D8*20150915
ViewLQ*68*235Z00000X
ViewREF*N5*;1;1149993
ViewHL*6*4*19*0
ViewNM1*1P*1*LodoliniKho*Ann****XX*1235508417
ViewN2*FIRST;100;F;19500101;N;;N;;88;002000;;N;N*11417331;OTH;CA;;CA;1D;1235508417
ViewN2*EMAIL;info@beaconhealthoptions.com
ViewLUI*LE*sgn***A
ViewDTP*092*D8*20151115
ViewLQ*68*103K00000X
ViewREF*N5*;1;11417331
ViewHL*7*4*19*0
ViewNM1*1P*1*Palmer*David****XX*1528425469
ViewN2*FIRST;100;M;19500101;N;;N;;88;002000;;N;N*11521261;OTH;CA;;CA;1D;1528425469
ViewN2*EMAIL;aaron@santacruzaba.com
ViewLUI*LE*sgn***A
ViewDTP*092*D8*20160815
ViewLQ*68*103K00000X
ViewREF*N5*;1;11521261
ViewHL*8*2*4*1
ViewNM1*QV*2*The Village Project Inc
ViewN2*611562515
ViewDTP*092*D8*20151015
ViewHL*9*8*N*1
ViewNM1*77*2*The Village Project Inc*****XX*1073758249
ViewN2*611562515;10;;27;;;;0;;;N*;;;;;N
ViewPER*AJ**TE*8313921500*EM*mel@villageprojectinc.org
ViewDTP*092*D8*20151015
ViewPDI**0*99
ViewNX1*77
ViewN3*1069 Broadway Avenue*Suite 201
ViewN4*Seaside*CA*93955
ViewLQ*68*251S00000X
ViewTPB*3G
ViewREF*N5*20974;;
ViewNM1*30*2*The Village Project Inc*****EQ*611562515
ViewHL*10*9*19*0
ViewNM1*1P*1*Battle*Regina****XX*1508154469
ViewN2*FIRST;100;F;19500101;N;;N;;88;002000;;N;N*67681;MFT;CA;;CAG;1DAJ;1508154469
ViewN2*EMAIL;reginab@villageprojectinc.org
ViewDTP*092*D8*20170115
ViewLQ*68*101YP2500X
ViewREF*N5*;1;67681
ViewHL*11*9*19*0
ViewNM1*1P*1*Mason*Melvin****XX*1548438419
ViewN2*FIRST;100;M;19500101;N;;N;;88;002000;;Y;N*20974;CSW;CA;;CAG;ADSGPDIC1D;1548438419
ViewN2*EMAIL;mel@villageprojectinc.org
ViewDTP*092*D8*20151015
ViewLQ*68*1041C0700X
ViewREF*N5*;1;20974
ViewHL*12*2*4*1
ViewNM1*QV*2*ARETE PHARMACY NETWORK
ViewN2*860318370
ViewDTP*092*D8*20061101
ViewHL*13*12*N*0
ViewNM1*77*2*ROMIE LANE PHARMACY INC*****XX*1558456988
ViewN2*860318370;3P;;27;;;;0;;;N*;;;;;N
ViewPER*AJ**TE*8314240395*EM*ROSTARELLO@GMAIL.COM
ViewDTP*092*D8*19000101
ViewNX1*77
ViewN3*505 E ROMIE LN*STE H
ViewN4*SALINAS*CA*93901
ViewLQ*68*333600000X
ViewREF*N5*PHY45642;;
ViewNM1*30*2*ARETE PHARMACY NETWORK*****EQ*860318370
ViewHL*14*2*4*1
ViewNM1*QV*2*ACCESS IV INC
ViewN2*020653265
ViewDTP*092*D8*20050201
ViewHL*15*14*N*0
ViewNM1*77*2*BRIOVARX INFUSION SERVICES 401, LLC*****XX*1093716813
ViewN2*020653265;3P;;27;;;;0;;;N*;;;;;N
ViewPER*AJ**TE*8313848080*EM*REGULATORY@BRIOVARXINFUSION.COM
ViewDTP*092*D8*20040604
ViewNX1*77
ViewN3*455 RESERVATION RD*STE G
ViewN4*MARINA*CA*93933
ViewLQ*68*3336H0001X
ViewREF*N5*PHY53892;;
ViewNM1*30*2*ACCESS IV INC*****EQ*020653265
ViewHL*16*2*4*1
ViewNM1*QV*2*Stewart, Sheryl
ViewN2*561921250
ViewDTP*092*D8*20140101
ViewHL*17*16*N*1
ViewNM1*77*2*Stewart, Sheryl*****XX*1952595134
ViewN2*561921250;10;;27;;;;0;;;N*;;;;;N
ViewPER*AJ**TE*8313732502*EM*stewart.sheryl@att.net
ViewDTP*092*D8*20140101
ViewPDI**0*99
ViewNX1*77
ViewN3*9 West Gabilan Street*Suite 8
ViewN4*Salinas*CA*93901
ViewLQ*68*101YM0800X
ViewTPB*3G
ViewREF*N5*46741;;
ViewNM1*30*2*Stewart, Sheryl*****EQ*561921250
ViewHL*18*17*19*0
ViewNM1*1P*1*Stewart*Sheryl****XX*1952595134
ViewN2*FIRST;100;F;19500101;N;;N;;88;002000;;Y;N*46741;MFT;CA;;CAG;ADMDAJDS;1952595134
ViewN2*EMAIL;Stewart.sheryl@att.net
ViewDTP*092*D8*20140101
ViewLQ*68*101YM0800X
ViewREF*N5*;1;46741
ViewHL*19*2*4*1
ViewNM1*QV*2*Torissi, Laura
ViewN2*611325891
ViewDTP*092*D8*20160315
ViewHL*20*19*N*1
ViewNM1*77*2*Torissi, Laura*****XX*1194029215
ViewN2*611325891;10;;27;;;;0;;;N*;;;;;N
ViewPER*AJ**TE*8312003085*EM*dr.laura.torissi@gmail.com
ViewDTP*092*D8*20160315
ViewPDI**13*64
ViewNX1*77
ViewN3*510 Lighthouse Avenue*Suite 6
ViewN4*Pacific Grove*CA*93950
ViewLQ*68*101YM0800X
ViewREF*N5*27534;;
ViewNM1*30*2*Torissi, Laura*****EQ*611325891
ViewHL*21*20*19*0
ViewNM1*1P*1*Torissi*Laura****XX*1194029215
ViewN2*FIRST;100;F;19500101;N;;N;;88;002000;;Y;N*27534;PSY;CA;;CA;1DSRADAJDS;1194029215
ViewN2*EMAIL;dr.laura.torissi@gmail.com
ViewDTP*092*D8*20160315
ViewLQ*68*101YM0800X
ViewREF*N5*;1;27534
ViewHL*22*2*4*1
ViewNM1*QV*2*Kihara, Ann
ViewN2*565809447
ViewDTP*092*D8*20140101
ViewHL*23*22*N*1
ViewNM1*77*2*Kihara, Ann*****XX*1497965164
ViewN2*565809447;10;;27;;;;0;;;N*;;;;;N
ViewPER*AJ**TE*8316553954*EM*ligureanna@msn.com
ViewDTP*092*D8*20140101
ViewPDI**0*99
ViewNX1*77
ViewN3*199 17th Street*Suite H
ViewN4*Pacific Grove*CA*93950
ViewLQ*68*106H00000X
ViewTPB*3G
ViewREF*N5*41385;;
ViewNM1*30*2*Kihara, Ann*****EQ*565809447
ViewHL*24*23*19*0
ViewNM1*1P*1*Kihara*Ann****XX*1497965164
ViewN2*FIRST;100;F;19500101;N;;N;;88;002000;;N;N*41385;MFT;CA;;CAG;AJ;1497965164
ViewN2*EMAIL;ligureanna@msn.com
ViewDTP*092*D8*20141208
ViewLQ*68*106H00000X
ViewREF*N5*;1;41385
ViewHL*25*2*4*1
ViewNM1*QV*2*Allen, Jennifer Lynn
ViewN2*462705713
ViewDTP*092*D8*20160615
ViewHL*26*25*N*1
ViewNM1*77*2*Jennifer Allen*****XX*1134586050
ViewN2*462705713;10;;27;;;;0;;;N*;;;;;N
ViewPER*AJ**TE*8312779348*EM*boneknowing@gmail.com
ViewDTP*092*D8*20160615
ViewPDI**0*99
ViewNX1*77
ViewN3*26485 Carmel Rancho Boulevard*Suite 5
ViewN4*Carmel*CA*93923
ViewLQ*68*106H00000X
ViewTPB*3G
ViewREF*N5*38327;;

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.



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