HL7 Messages & Technical Specifications for Medical Services Plan

Technical specifications for HL7 messages are posted as individual documents. Collectively they are referred to as Volume 4 of the Software Compliance Standards documentation.

Developers can refer to the Transaction Dictionary in Volume 1 to determine which message specifications they require. Transaction business requirements are in Volume 3 publications.

The messages listed on this page have been approved for vendor development.

Unless otherwise indicated, the documents are in PDF format.

ACK General Acknowledgement
E45 Query Eligibility
R15 Check Beneficiary Coverage Status
R20 Record Document
R30 Establish Payer Relationship
R31 Establish Payer Relationship for Dependent
R32 Get Contract Periods
R34 Update Employee Number and/or Department
R35 End Payer Relationship
R36 End Payer Relationship for Dependent
R37 Get Account Contract Address
R38 Update Account Contract Address
R40 Account Contract Inquiry
R41 New Payer Inquiry
R42 PHN Lookup
R43 Z29 Reinstate Overage Dependent
R44 Z28 Reinstate Cancelled Coverage
R45 Z27 Renew Cancelled Coverage
R46 Z26 Update Premium Payment Periods
R50 Enroll Subscriber
R50 Z03 Enroll Subscriber with PHN
R50 Z04 Enroll Subscriber without PHN
R50 Z05 Enroll Visa Subscriber without PHN
R50 Z06 Enroll Visa Subscriber with PHN
R51 Extend Visa Resident Cancel Date
ALL
 
Zipped Collection of Medical Services Plan Messages above (ZIP, 1.5MB)