276/277 Health Care Claim Status Request and Response Companion Guides (Health Partners Plans)
276/277 Health Care Claim Status Request and Response transactions are included into Health Partners Plans EDI program. Electronic Data Interchange (EDI) customer service and technical assistance requests focus solely on the generation, processing, and/or transmission of a HIPAA standard transaction 276/277 Health Care Claim Status Request and Response. EDI customer service and technical assistance requests will not focus on transaction results such as claim payment and remittance results.
EDI Claim Status Request (276)
The purpose of generating a 276 is to obtain the current status of the claim(s) within the adjudication process. A claim is located by supplying Health Partners Plans the following information:
- Member ID
- Provider ID
- Member Name and Date of Birth
- Member Gender
A service start and end date can also be supplied to further narrow the search for the claim(s). If no Service Date is supplied, then only claims from the previous 90 days will be returned.
EDI Claim Status Response (277)
The following are the Claims Status Response Values utilized by Health Partners Plans:
- Requesting and Submitting Provider ID Number
- Member Name and Date of Birth
- Member ID Number and Gender
- Claim Status and Date of Service
- Claim Number and EOP Codes
- Billed Amount, Paid Amount and Check Number
If the 276 request does not uniquely identify the claim within Health Partners Plans system, the response may include multiple claims that meet the identification parameters supplied by the requester. In the event that the member or the claim(s) are not found in Health Partners Plans database, Health Partners Plans will return a 277 transaction set containing a STC segment identifying the element which was not found.
This information is intended to be a companion guide for use in conjunction with the ASCX12N National Electronic Data Interchange Transaction Set Implementation and Addenda Guides. The information in this post is provided for Health Partners Plans, Inc. and its associated Trading Partners.