Patient Information

Patient information in healthcare supply chains flows bidirectionally across providers, payers, and clearinghouses. This X12 275 transaction set enables the transmission of patient demographic, identification, and service-related data, typically sent in response to inquiries or requests for patient information updates. The transaction uses the ST (Transaction Set Header) segment to open the message, the NM1 (Individual or Organizational Name) segment to identify patients and associated parties, and the DMG (Demographic Information) segment to convey patient characteristics such as age and gender. The structure supports hierarchical organization through loops that allow multiple providers, contact persons, and service dates to be associated with a single patient record, making it suitable for complex healthcare scenarios involving referrals or multi-facility coordination.

Consider a scenario where Blue Cross Blue Shield (BCBS) requests updated patient information from Community Medical Center to verify eligibility and current contact details. Community Medical Center responds with a 275 transaction that includes the patient’s name and identification number via the NM1 and IN1 segments, their current address and demographics through the N3, N4, and DMG segments, and relevant provider contacts using the PER segment. If the patient has received care at multiple locations or from different specialists, the transaction can include multiple date/service detail loops (LX loop with DTP segments) showing which providers delivered services and when. This enables BCBS to maintain accurate records without requiring phone calls or manual record requests between organizations.