The EDI 277
Health Care Claim Status Response transaction set is used by healthcare payers (insurance companies, Medicare, etc.) to report on the status of claims (837 transactions
) previously submitted by providers.
The 277 transaction, which has been specified by HIPAA for the submission of claim status information, can be used in one of the following three ways:
- A 277 transaction may be sent in response to a previously received EDI 276 Claim Status Inquiry
- A payer may use a 277 to request additional information about a submitted claim (without a 276)
- A payer may provide claim status information to a provider using the 277, without receiving a 276
Information provided in a 277 transaction generally indicates where the claim is in process, either as Pending or Finalized. If finalized, the transaction indicates the disposition of the claim – rejected, denied, approved for payment or paid.
If the claim was approved or paid, payment information may also be provided in the 277, such as method, date, amount, etc. If the claim has been denied or rejected, the transaction may include an explanation, such as if the patient is not eligible.
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ISA*00* *00* *01*1234567890 *01*999999999 *120126*1211*U*00401*000000632*0*P*\
GS*ME*1234567890 *999999999 *20120126*1211*1*T*004010
REF*01*Reference Identification*Description*01\Reference Identification\01\Reference Identification\01\Reference Identification
DMG*CC*Date Time Period*A***1
NM1*01*1*Name Last or Organization Name**Name Middle*Name Prefi****01*01
N4*City Name**POSTAL CODE*COU
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe
STC*Industry Code\Industry Code\01**1*10548281732963524**20120314*****Industry Code\Industry Code
REF*01*Reference Identification**01\Reference Identification\\\01\Reference Identification
DTP*001*CC*Date Time Period
This X12 Transaction Set contains the format and establishes the data contents of the Health Care Information Status Notification Transaction Set (277) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used by a health care payer or authorized agent to notify a provider, recipient, or authorized agent regarding the status of a health care claim or encounter or to request additional information from the provider regarding a health care claim or encounter, health care services review, or transactions related to the provisions of health care. This transaction set is not intended to replace the Health Care Claim Payment/Advice Transaction Set (835) and therefore, will not be used for account payment posting. The notification may be at a summary or service line detail level. The notification may be solicited or unsolicited.