EDI 277 Health Care Information Status Notification

Common T-Sets > X12 EDI T-Sets / EDIFACT EDI T-Sets

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. Want to meet HIPAA requirements without the upfront investment in IT resources? Let the experts at 1EDISource handle everything with a complete EDI Outsourcing program. To discuss how your healthcare transactions can be more effective and efficient, contact 1EDISource.

EDI 277 Format

ISA*01*0000000000*01*0000000000*ZZ*ABCDEFGHIJKLMNO*ZZ*123456789012345*101127*1719*U*00400*000003438*0*P*> GS*ME*1234567890 *999999999 *20120126*1211*1*T*004010 ST*277*0001 BHT*0001*00*Reference Identification**1744480 REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification HL*1**1 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 TRN*1*Reference Identification STC*Industry CodeIndustry Code1**1*10548281732963524**20120314*****Industry CodeIndustry Code REF*01*Reference Identification**01Reference Identification\1Reference Identification DTP*001*CC*Date Time Period SE*13*0001 GE*1*1 IEA*1*000000632

EDI 277 Specification

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.

Sources

Accredited Standards Committee X12. ASC X12 Standard [Table Data]. Data Interchange Standards Association, Inc., Falls Church, VA. http://www.x12.org