276/277 Health Care

276/277 Health Care Claim Status Request and Response

The purpose of generating a 276 Claim Status Request 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.

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.

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

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