Attachment L
Updated
A Word document (29 KB) attached to Health Care Clearinghouse 1 - HIPAA Electronic Transactions and Insurance Discovery (VA-27-00018291) | Maxel/Svendsen, from the Department of Veterans Affairs. Due Nov 3, 2026, 10:00 AM (UTC-5).
File name: Attachment L.docx
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ATTACHMENT L – INSURANCE COVERAGE DISCOVERY INTERFACE
Contractor receives a message from VA indicating to search for insurance for this patient; formatted as:
Segment ID
Sample
HEADER
ISA
ISA*00* *00* *ZZ**<TBD> *ZZ*<TBD> *171212*1534*^*00501*100100100*0*P*:~
GS
GS*HS*<TBD>*<TBD>*20171212*1534*100100100*X*005010X279A1~
ST
ST*270*100100100*005010X279A1~
BHT
BHT*0022*13*539-539887766554*20171212*153400~
Loop ID 2000A – INFORAMTION SOURCE LEVEL
HL
HL*1**20*1~
Loop ID 2100A – INFORAMTION SOURCE NAME
NM1
NM1*PR*2*ELECTRONIC COVERAGE DISCOVERY*****PI*<TBD>~
Loop ID 2000B – INFORMATION RECEIVER LEVEL
HL
HL*2*1*21*1~
Loop ID 2100B – INFORMATION RECEIVER NAME
NM1
NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~
Loop ID 2000C – SUBSCRIBER LEVEL
HL
HL*3*2*22*0~
TRN
TRN*1*100100100*9ECTRACE ~
Loop ID 2100C – SUBSCRIBER NAME
NM1
NM1*IL*1*LAST*FIRST*<M>***MI*100200300~
N3
N3*1001 VA BLVD~
N4
N4*CINCINNATI*OH*45201~
DMG
DMG*D8*19450101*M~
DTP
DTP*291*D8*20171212~
Loop ID 2110C – SUBSCRIBER ELIGIBILITY OR BENEFIT INQUIRY
EQ
EQ*30~
TRAILER
SE*13*100100100~
GE*1*100100100~
IEA*1*100100100~
*where <TBD> indicates VA originating facility
Contractor sends a message to VA confirming receipt of initial patient demographics for insurance search; formatted as: Segment ID
Sample
HEADER
ST
ST*271*100100101*005010X279A1~
BHT
BHT*0022*11*539-539887766554*20171212*153400~
LOOP ID 2000A—INFORAMTION SOURCE LEVEL
HL
HL*1**20*1~
LOOP ID - 2100A INFORAMTION SOURCE NAME
NM1
NM1*PR*2*ELECTRONIC COVERAGE DISCOVERY*****PI*<TBD>~
LOOP ID - 2000B INFORMATION RECEIVER LEVEL
HL
HL*2*1*21*1~
LOOP ID - 2100B INFORMATION RECEIVER NAME
NM1
NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~
LOOP ID - 2000C SUBSCRIBER LEVEL
HL
HL*3*2*22*0~
TRN
TRN*2*100100100*9ECTRACE ~
LOOP ID - 2100C SUBSCRIBER NAME
NM1
NM1*IL*1*LAST*FIRST*M***MI*100200300~
N3
N3*1001 VA BLVD~
N4
N4*CINCINNATI*OH*45201~
AAA
AAA*Y**63*W~
DMG
DMG*D8*19450101*M~
DTP
DTP*291*D8*20171212~
TRAILER
SE
SE*13*100100101~
*where <TBD> indicates VA originating facility
**where AAA*Y**63*W~ is mutually defined as please wait X number of days to submit status check one and can be reformatted to mutually agreeable 2100X/AAA response.
Contractor shall receive a message from VA after X time interval, requesting if search results are available (aka: status check) . The status check message would be a retransmission of the original 270 except for the date/time stamp, which reflect current date and time.
Contractor sends a message to VA indicating results are not ready; formatted as:
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