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Spotlight PEPPOL BIS Billing 3.0 The EU e-invoicing mandate is here — France Sept 2026, Belgium Jan 2026, Germany 2025.

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Foundations

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Standards

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Flagship messages

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Tools

X12 274 — Healthcare Provider Information

The 274 transmits structured healthcare provider information between payers, intermediaries, and directories: credentialing, NPI, taxonomy, network status.

Purpose

The 274 documents the identity and capabilities of a healthcare provider: NPI (National Provider Identifier), HCPCS taxonomy code, licenses, specialties, locations, network affiliations. It feeds payer provider directories (required by CMS for Medicare Advantage / Marketplace plans) and credentialing networks (CAQH).

It is used for initial directory loads, periodic updates, post-credentialing corrections. Acknowledged by 997. Anomalies or rejections flow through 824.

Envelope structure

The 274 travels within the three X12 envelope levels (ISA/IEA, GS/GE with functional group HP, and ST/SE). Didactic example in release 004010:

x12 example-274.x12 
ISA*00*          *00*          *ZZ*CAQHNETWORK   *ZZ*PAYER1         *260514*1900*U*00401*000000274*0*P*>~
GS*HP*CAQHNETWORK*PAYER1*20260514*1900*1*X*004010~
ST*274*0001~
BGN*00*HP-2026-0042*20260514~
NM1*82*1*SMITH*ANNE*M***XX*NPI-1234567893~
REF*ZZ*TAXONOMY-207RC0000X~
REF*ZZ*LICENSE-MD-TX-K12345~
N3*100 MEDICAL DRIVE~
N4*HOUSTON*TX*77030*US~
LX*1~
REF*ZZ*NETWORK-PPO-IN~
DTM*RT*20260101~
SE*10*0001~
GE*1*1~
IEA*1*000000274~

Common segments

  • Header — ST, BGN.
  • Provider — NM1*82 (Rendering Provider) with NPI, REF*ZZ (taxonomy), REF*ZZ (license).
  • Locations — N3/N4, PER for contacts per location.
  • Network affiliations — LX loop: REF*ZZ (network ID, status IN/OUT), DTM*RT (period).
  • Summary — SE.

Common pitfalls

  • NPI validation: the 10-digit NPI must have a valid ISO 7812 check digit; an invented NPI is rejected by the CMS NPPES API.
  • Taxonomy precision: the NUCC taxonomy goes to sub-specialty (e.g., 207RC0000X = Cardiology, 207RC0200X = Cardiovascular Disease); a too-broad taxonomy distorts member-to-provider matching.
  • CMS directory accuracy: CMS requires 95% accuracy from Medicare Advantage payers (CFR §422.111); an incomplete or outdated 274 exposes the payer to CMP penalties.

Documentation

The code 274 and the name Healthcare Provider Information are public and listed on x12.org/products/transaction-sets. The complete structure of loops, qualifiers and code lists is distributed by DISA via the proprietary Implementation Guides (TR3). ediverse.io covers only public concepts, the envelope and didactic examples.