276-277 EDI Transaction Guides

Medical Associates Health Plan 276-277 EDI Transaction Guides

Before submitting or receiving a 276 or 277 transaction, registration as a Trading Partner with Change HealthCare and testing is required. Before testing with Change HealthCare can begin:

  • Connectivity with Change HealthCare’s Real-Time Exchange Services must be established. The Implementation Coordinator will work to facilitate the setup and testing of connectivity and communications.
  • Develop HIPAA and ASC/X12-compliant transaction sets. Transaction sets can be developed before connectivity with Change HealthCare is established. It is strongly recommended that transactions are checked for compliance to 005010 standards using a compliance checker. Change HealthCare has partnered with Edifecs for this purpose and will activate an Edifecs account for the trading partner.

Process Flow

The process flow for the 276/277 transaction exchange will involve two separate entities: The provider or clearinghouse sending the claim status request, and Change HealthCare. Change HealthCare will serve as an intermediary between the request source and MAHP/HC, storing the benefit data for MAHP/HC and exchanging the claim status response through their secure connections.

Change HealthCare will return a 277 response or 999 (in case of failed validation) within 20 seconds of receiving the 276 request from a submitter to provide as close to a real-time response as possible. Automation is currently configured to run 24 hours a day in order to process requests as submitted.

Re-Transmission Procedure MAHP/HC

Real-Time Exchange Services through Change HealthCare do not perform re-transmissions. It is the Trading Partner’s responsibility to resubmit.

Communication Protocol

Change HealthCare’s security protocol is Username/Password. Change HealthCare does not use X.509. The currently supported protocol for CORE is HTTP/S. The following is a list of standards and the versions that this Rule is based on:

  • HTTP Version 1.1
  • SSL Version 3.0
  • MIME Version 1.0
  • The MIME Multipart/Form-Data (IETF RFC 2388)
  • SOAP Version 1.2
  • WSDL Version 1.1
  • Web Services-Security 1.1 Change HealthCare utilizes SOAP, MIME/Multipart, and WSDL.

To learn more about EDI and become a certified EDI Professional, please visit our course schedule page.

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