X12 274 provider directory transaction handling

Steps

1. Understand the X12 274 (Healthcare Provider Information) transaction set — it is used to exchange provider demographic, credential, and network affiliation data between provider networks, payers, and credentialing organizations.
2. Build or receive the ISA/GS envelope with the correct sender/receiver IDs for the trading partner agreement, followed by the ST 274 transaction set identifier.
3. Populate the PRV (Provider Information) loop with NPI, taxonomy code, and provider type; populate the N3/N4 loops with practice address and the PER loop with contact information.
4. Include the REF segment for supplemental identifiers (DEA number, state license number, UPIN if applicable) and the DTP segment for effective and termination dates of directory membership.
5. Transmit via your clearinghouse or direct EDI channel using the agreed transport (AS2, SFTP, or VAN); confirm with a TA1 interchange acknowledgment and a 999 functional acknowledgment.
6. Process inbound 274 files by parsing each provider loop and upserting records in your directory database using NPI as the primary key.