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2026 CBCS EXAM PREP
2026 HIPAA TRANSACTION AND CODE SETS & 5 CORE MEDICAL CODE SETS
| Term | Definition |
|---|---|
| HIPAA TRANSACTION CODES (*high yield) | Standard electronic messages used to send healthcare and insurance information between covered entities. |
| X12 270* | DETERMINE ELIGIBILITY BENEFIT INQUIRY (requests eligibility/ benefits information) KEYWORD: ELIGIBILITY |
| X12 271* | ELIGIBILITY BENEFIT RESPONSE (provides eligibility and benefits information) KEYWORD: ELIGIBILITY |
| X12 276* | CLAIM STATUS INQUIRY (requests claim status) KEYWORD: CLAIM STATUS |
| X12 277* | CLAIM STATUS RESPONSE (provides claim status) KEYWORD: CLAIM STATUS |
| X12 278* | REFERRAL CERTIFICATION AND AUTHORIZATION (requests prior authorization and referrals) KEYWORD: AUTHORIZATION |
| X12 820 | HEALTH PLAN PREMIUM PAYMENT (transmits premium payments) KEYWORD: PREMIUM PAYMENT |
| X12 834 | BENEFIT ENROLLMENT/MAINTENANCE (enrolls, updates, or disenrolls members) KEYWORD: ENROLLMENT |
| X12 835* | SEND PAYMENT/REMITTANCE ADVICE (explains claim payments, denials, and adjustments) KEYWORD: PAYMENT |
| X12 837* | HEALTH CARE CLAIMS (submits healthcare claims from providers to payers for reimbursement) KEY WORD: CLAIM |
| X12 839 (low yield) | CLAIM ADJUSTMENT |
| X12 1001 (low yield) | OLDER CODE - MODERN 834 ENROLLMENT/DISENROLLMENT; |
| X12 1002 (low yield) | OLDER CODE - MODERN 820 PREMIUM PAYMENT; |
| COORDINATION OF BENEFITS (COB) | Used to determine payment responsibility when a patient has multiple insurance plans |
| HEALTH CARE CLAIMS ATTACHMENT | Used to transmit supporting documentation for a claim, such as medical records/reports |
| FIRST REPORT OF INJURY | Used to report a work-related injury or illness, typically for workers' compensation |
| HIPAA FIVE CORE MEDICAL CODE SETS | Standardized code sets to identify diagnoses, procedures, and other data elements |
| CDT | CODE ON DENTAL PROCEDURES AND NOMENCLATURE (dental procedures/services) |
| CPT | CURRENT PROCEDURAL TERMINOLOGY (outpatient procedures/services) |
| HCPCS Level II | HEALTH CARE COMMON PROCEDURE CODING SYSTEM (medications, procedures, services, and supplies) |
| ICD-10-CM | INTERNATIONAL CLASSIFICATION OF DISEASES, 10th EDITION, CLINICAL MODIFICATION (diagnoses, diseases, injuries, conditions) |
| ICD-10-PCS | INTERNATIONAL CLASSIFICATION OF DISEASES, 10th REVISION, PROCEDURE CODING SYSTEM (inpatient hospital procedures) |
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