Each X12 implementation guide explains how to use X12 transaction sets to meet a single defined business purpose. The following diagrams depict various exchanges between trading partners based on the implementation guides developed within the X12’s Insurance subcommittee (X12N). Trading partners for these exchanges include health plans, health care service providers, and other entities that administer health plan services, fund health plans, or enroll members. Some of these transactions have been adopted under HIPAA and those are bolded.
The diagrams are intentionally simplified for presentation purposes. The transactions can be transmitted at various times in the care delivery cycle, not just in the order depicted here. Similarly, other trading partners can and do exchange the transactions described in the diagrams for the same or similar purposes.