Healthcare 276 and 277 Claim Status Request (276) and Claim Status Notification (277) definition
Healthcare 276 and 277 EDI transactions described in today’s post refer to HIPAA EDI definitions. The 276 Claim Status Request can be used by a provider to request status of a claim. Key elements used on the request are provider number, patient identifier, dates of services and charges. Specific trace numbers can be used on the Healthcare 276 and 277 to relate the status to the original request.
The 277 Claim Status Notification can be used two ways:
- Payer can issue a 277 as a response to a 276 request.
- Payer can request additional information about a submitted claim, without a 276.
- Payer can submit an Unsolicited 277 Claim Status Response, providing the status of the claim without a 276.
The key element for providing the status notification is the STC segment which consists of Claim Status categories Claim Status Codes and monetary amounts. Some example categories and codes are:
- F – Finalized – these claims have completed the adjudication process and some return codes can be rejected, denied, approved for payment, or paid
- P – Pending – these claims and some return codes can be in process, payer review, provider requested information and etc.
Healthcare 276 and 277 transactions flow and interaction with other transactions
The Healthcare 276 and 277 transactions flow variant 1 shows the following process:
- Provider has submitted an 837 claim and received a 999 acknowledgement.
- Provider requested status of the claim by issuing the 276.
- Payer has responded to the 276 by issuing a 277 status response.
The Healthcare 276 and 277 transactions flow variant 2 shows how a 277 can be sent can be sent providing unsolicited claim status notification or how a 277 can be sent requesting additional information:
- Provider has submitted an 837 claim and received a 999 acknowledgement.
- Payer issues an unsolicited claim status notification to the provider (without a 276) (or another scenario).
- Payer issues a 277 as a request for additional information.
The various uses of the 277 can be determined by GS-08, ST-03 or BHT-06. BHT-06 will contain one of the following code values:
• DG – Response (Health Care Claim Status Request and Response)
• NO – Notice (Health Care Claim Pending Status Information)
• RQ – Request (Health Care Claim Request for Additional Information)
• TH – Receipt Acknowledgment Advice (Health Care Claim Acknowledgment).