276 Healthcare Claim Status Request

X212 Claim Status Request EDI Transaction

The 276 X212 – Claim Status Request transaction is a standardized electronic data interchange transaction used in the healthcare industry, particularly within the United States, for querying the status of healthcare claims. This transaction is part of the ANSI X12 EDI standards, which define the structure and format for exchanging various types of healthcare-related information electronically.

The purpose of the 276 X212 transaction is to enable healthcare providers, billing companies, and other entities involved in claims processing to inquire about the status of a submitted healthcare claim. This inquiry typically includes details such as the patient’s information, the service provided, the date of service, and other relevant identifiers necessary to track and locate the specific claim in question.

Key components typically included in a 276 X212 transaction may comprise:

1. Identification information: Details to identify the entity making the inquiry, such as the sender’s name, address, and contact information.
2. Claim information: Specific details about the claim being queried, including the claim number, patient information (e.g., name, date of birth), service dates, and any other pertinent identifiers.
3. Request type: Indicates the nature of the inquiry, such as a request for the current status of the claim, a request for additional information needed to process the claim, or a request for the reason for claim denial.
4. Provider information: Identifying details of the healthcare provider submitting the claim.
5. Payer information: Identifying details of the insurance payer to whom the claim was submitted.

The usage of the 276 X212 transaction facilitates efficient communication between healthcare providers and insurance payers by providing a standardized method for querying claim status information. By electronically transmitting these inquiries, providers can streamline the process of tracking claims, reduce administrative burden, and expedite the resolution of outstanding claims.

For healthcare organizations, the ability to receive timely updates on the status of their claims helps in managing revenue cycles more effectively, identifying and resolving claim denials or discrepancies promptly, and ensuring smooth cash flow. Additionally, the use of EDI standards like the 276 X212 transaction promotes interoperability among different stakeholders in the healthcare ecosystem, leading to improved efficiency and accuracy in claims processing.

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