276 EDI Health Care Claim Status Request Specifications
The EDI 276 transaction set is a Health Care Claim Status Inquiry. It is used by healthcare providers to verify the status of a claim submitted previously to a payer, such as an insurance company, HMO, government agency like Medicare or Medicaid, etc.
The 276 transaction is specified by HIPAA for the electronic submission of claim status requests. The transaction typically includes:
- Provider identification
- Patient identification
- Subscriber information
- Date(s) of service(s)
- Charges
EDI 276 Format
EDI 276 Specification
This X12 Transaction Set contains the format and establishes the data contents of the Health Care Claim Status Request Transaction Set (276) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used by a provider, recipient of health care products or services, or their authorized agent to request the status of a health care claim or encounter from a health care payer. This transaction set is not intended to replace the Health Care Claim Transaction Set (837), but rather to occur after the receipt of a claim or encounter information. The request may occur at the summary or service line detail level.
Sources
Accredited Standards Committee X12. ASC X12 Standard [Table Data]. Data Interchange Standards Association, Inc., Falls Church, VA. http://www.x12.org