Attachment L.docx

DOCX document 29 KB Posted Oct 29, 2026

Attached to: Q601--Health Care Clearinghouse 1 - HIPAA Electronic Transactions and Insurance Discovery (VA-27-00018291) | Maxel/Svendsen
Solicitation number: 36C24C27Q0007
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9

About this file

Written by GovTribe AI · Oct 29, 2026

This is a technical specification attachment detailing the Insurance Coverage Discovery Interface communication protocol for electronic health insurance transactions between the Veterans Health Administration (VHA) and a contractor.

The attachment specifies the X12 EDI (Electronic Data Interchange) message format standards for HIPAA 270/271 eligibility and benefit inquiry and response transactions. The contractor must receive and process patient insurance search requests from VHA's Austin Financial Services Center using standardized 270 messages containing patient demographics (name, date of birth, address, member identification). The contractor must then respond with formatted 271 messages indicating: (1) receipt and processing of the inquiry, (2) interim status updates when results are not immediately available using mutually agreed upon time intervals with AAA segment codes (such as "please wait X days"), or (3) final results showing discovered insurance policies with payer information, coverage types (medical, pharmacy, mental health, other), group numbers, and dependent information where applicable. If no insurance policies are found, the contractor transmits a 271 response with an AAA segment code indicating no coverage was located. The message structure uses standardized X12 loops and segments including NM1 (name), N3/N4 (address), REF (reference identification), DMG (demographic), DTP (date), EB (eligibility/benefit), and LS/LE (loop start/end) segments. All communications follow the 005010X279A1 implementation convention for healthcare eligibility transactions.

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Other files

File	Type	Posted
Attachment B.docx	DOCX document	Oct 29, 2026
Attachment K.docx	DOCX document	Oct 29, 2026
Attachment D.docx	DOCX document	Oct 29, 2026
Attachment F.docx	DOCX document	Oct 29, 2026
Attachment A.docx	DOCX document	Oct 29, 2026
Attachment H.docx	DOCX document	Oct 29, 2026
Attachment G.docx	DOCX document	Oct 29, 2026
36C24C27Q0007.docx	DOCX document	Oct 29, 2026
P02 - 36C24C27Q0007 - NOI.docx	DOCX document	Oct 29, 2026
Attachment I.docx	DOCX document	Oct 29, 2026
P01 - PWS - HCCH I - 10.29.2026.docx	DOCX document	Oct 29, 2026
Attachment M.docx	DOCX document	Oct 29, 2026
Attachment C - Projected Total Transaction Volumes.docx	DOCX document	Oct 29, 2026
Attachment E.docx	DOCX document	Oct 29, 2026
Attachment J.docx	DOCX document	Oct 29, 2026

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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*HS*<TBD>*<TBD>*20171212*1534*100100100*X*005010X279A1~

ST*270*100100100*005010X279A1~

BHT

BHT*0022*13*539-539887766554*20171212*153400~

Loop ID 2000A – INFORAMTION SOURCE LEVEL

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*2*1*21*1~

Loop ID 2100B – INFORMATION RECEIVER NAME

NM1

NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~

Loop ID 2000C – SUBSCRIBER LEVEL

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*1001 VA BLVD~

N4*CINCINNATI*OH*45201~

DMG

DMG*D8*19450101*M~

DTP

DTP*291*D8*20171212~

Loop ID 2110C – SUBSCRIBER ELIGIBILITY OR BENEFIT INQUIRY

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*271*100100101*005010X279A1~

BHT

BHT*0022*11*539-539887766554*20171212*153400~

LOOP ID 2000A—INFORAMTION SOURCE LEVEL

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*2*1*21*1~

LOOP ID - 2100B INFORMATION RECEIVER NAME

NM1

NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~

LOOP ID - 2000C SUBSCRIBER LEVEL

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*1001 VA BLVD~

N4*CINCINNATI*OH*45201~

AAA

AAA*Y**63*W~

DMG

DMG*D8*19450101*M~

DTP

DTP*291*D8*20171212~

TRAILER

SE*13*100100101~

**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:

Segment ID

Sample

HEADER

ST*271*100100101*005010X279A1~

BHT

BHT*0022*11*539-539887766554*20171212*153400~

LOOP ID 2000A—INFORAMTION SOURCE LEVEL

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*2*1*21*1~

LOOP ID - 2100B INFORMATION RECEIVER NAME

NM1

NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~

LOOP ID - 2000C SUBSCRIBER LEVEL

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*1001 VA BLVD~

N4*CINCINNATI*OH*45201~

AAA

AAA*Y**63*X~

DMG

DMG*D8*19450101*M~

DTP

DTP*291*D8*20171212~

TRAILER

SE*13*100100101~

**where AAA*Y**63*X~ is mutually defined as please wait X number of days to -re-submit status check two and can be reformatted to mutually agreeable 2100X/AAA response.

Contractor sends a message to VA indicating results are ready, 1 policy found; formatted as:

Segment ID

Value

Sample

Header

ST*271*100100101*005010X279A1~

BHT

BHT*0022*11*539-539887766554*20171212*153400~

Loop ID 2000A—INFORAMATION SOURCE LEVEL

HL*1**20*1~

LOOP ID - 2100A INFORMATION SOURCE NAME 1

NM1

NM1*PR*2*ELECTRONIC COVERAGE DISCOVERY*****PI*<TBD>~

LOOP ID - 2000B INFORMATION RECEIVER LEVEL

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*3*2*22*0~

TRN

TRN*2*100100100*9ECTRACE ~

LOOP ID - 2100C SUBSCRIBER NAME

NM1

NM1*IL*1*LAST*FIRST*M***MI*100200300~

N3*1001 VA BLVD~

N4*CINCINNATI*OH*45201~

DMG

DMG*D8*19450101*M~

DTP

DTP*291*D8*20171212~

LOOP ID - 2110C SUBSCRIBER ELIGIBILITY OR BENEFIT INFORMATION

<2110C EB*R is expected to repeat for each policy found>

EB*R**30**Plan name (if available)~

LOOP ID - 2115C SUBSCRIBER ELIGIBILITY OR BENEFIT ADDITIONAL INFORMATION – NOT USED

<2110C LS is expected to repeat for each EB*R, but only one per EB*R>

LS*2120~

LOOP ID - 2120C SUBSCRIBER BENEFIT RELATED ENTITY NAME

<2120C is expected to repeat for each payer/policy combination, thus creating 2 2120C loops per policy found>

NM1

NM1*PR*2*Payer Name******PI*123456~

REF

REF 01 Reference Identification Qualifier

M7 - M7 Medical Assistance Category

REF 02 Reference Identification

1 - Medical

2 - Pharmacy 3 - Mental Health 4 - Other

REF 03 Description

Medical, Pharmacy, Mental Health, Other

PER

PRV

NM1

NM101 Entity Identifier Code

IL -Insured or Subscriber

NM102 Entity Type Qualifier

1 - Person Entity

NM103 Name Last or Organization Name

Subscriber Name

NM104-NM107

Subscriber Name Information

NM108 - Identification Code Qualifier

MI - Member Identification Number

NM109 Identification Code

Member Policy Number

Optional on dependent policy

REF

REF 01 Reference Identification Qualifier

REF 02 Reference Identification

Group Number

REF

REF 01 Reference Identification Qualifier

REF 02 Reference Identification

SSN

DMG

DOB

PER

PRV

NM1

For Dependent policies only

NM101 Entity Identifier Code

03 - dependent

NM102 Entity Type Qualifier

1 - Person Entity

NM103 Name Last or Organization Name

Dependent Name

NM104-NM107

Dependent Name Information

NM108 - Identification Code Qualifier

MI - Member Identification Number

NM109 Identification Code

Member Policy Number

REF

REF 01 Reference Identification Qualifier

REF 02 Reference Identification

Group Number

REF

REF 01 Reference Identification Qualifier

REF 02 Reference Identification

SSN

DMG

DMG02 - Subscriber DOB

DOB

PER

PRV

LOOP ID - 2120D DEPENDENT BENEFIT RELATED ENTITY NAME – NOT USED

SE*13*100100101~

**Policy found message is a customized X12 271 message, with each found insurance returned using one EB*R and a single 2120 loop under it. At a high level, each patient and policy information would be structured as follows:

EB*R**30**plan name (if available)~

LS~

1st NM1 for the payer, with REF*M7 for type of policy (values 1 - Medical, 2 - , …) 2nd NM1 and related N3, N4, REF*6P, REF*SY, DMG segments for the subscriber 3rd NM1 optional for the dependent + related N3, N4, REF*6P, REF*SY, DMG segments

LE~

EB*R**30**plan name (if available)~ if another policy found etc.

Contractor sends a message to VA indicating Contractor could not find any policies for patient; formatted as:

Segment ID

Sample

HEADER

ST*271*100100101*005010X279A1~

BHT

BHT*0022*11*539-539887766554*20171212*153400~

LOOP ID 2000A—INFORAMTION SOURCE LEVEL

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*2*1*21*1~

LOOP ID - 2100B INFORMATION RECEIVER NAME

NM1

NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~

LOOP ID - 2000C SUBSCRIBER LEVEL

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*1001 VA BLVD~

N4*CINCINNATI*OH*45201~

AAA

AAA*Y**75*S~

DMG

DMG*D8*19450101*M~

DTP

DTP*291*D8*20171212~

TRAILER

SE*13*100100101~

**where AAA*Y**75*S~ is mutually defined as no insurance has been found.

File details come from the government source that posted it. Updated Oct 29, 2026.