Transactions Overview

What Is a Transaction?

A transaction is an electronic exchange of information between two parties to carry out financial or administrative activities related to health care. For example, a health care provider will send a claim to a health plan to request payment for medical services.

Health Care Transactions Basics (PDF)

Overview document of electronic transactions used in health care to increase efficiencies in operations, improve the quality and accuracy of information, and reduce the overall costs to the system.

Standards for Transactions

Under HIPAA, HHS adopted certain standard transactions for the electronic exchange of health care data. These transactions include:

Payment and remittance advice

Claim status

Eligibility

Coordination of benefits

Claims and encounter information

Enrollment and disenrollment

Referrals and authorizations

Premium payment

HIPAA covered entities who conduct any of these transactions electronically must use an adopted standard from ASC X12N or NCPDP (for certain pharmacy transactions).

Violations

You can submit complaints about potential transaction standard violations via the Administrative Simplification Enforcement and Testing Tool (ASETT). Learn how to file a complaint.

Download our Compliance Review Supplemental Resources zip file (ZIP) to learn about common violations.

Exceptions

An organization may request an exception from the use of a standard transaction from the Secretary to test a proposed modification to that standard. Learn about our exceptions process and the principles for requesting an exception (PDF).

Learn More

Transaction FAQs

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