San Francisco Health Plan EDI 276 and 277 Documents (Claim Status Request and Response)
San Francisco Health Plan EDI 276 and 277 transactions are used in tandem: the 276 transaction is used to inquire about the current status of a specified claim or claims, and the 277 transaction in a response to that inquiry. San Francisco Health Plan provides the ability for a practitioner or facility to submit a file for claim status for its members (HIPAA Eligibility Benefits Inquiry and Response 276-277 electronic transactions) through their designated clearinghouse or directly to their office as instructed. To establish a connection for the San Francisco Health Plan EDI 276 and 277 transactions, one should contact a clearinghouse in regard to setting up the ability to submit and receive the electronic claim status inquiries with San Francisco Health Plan. If you currently are not utilizing a software vendor you can contact San Francisco Health Plan EDI Team for alternatives. The information in the following blog post depicts San Francisco Health Plan EDI 276 and 277 transactions, version 5010 examples.
San Francisco Health Plan EDI 276 and 277 Examples
276 Sample Request
ISA*00* *00* *ZZ*SUBMITTER *ZZ*RECEIVER *130924*0536*^*00501*001972007*0*P*:
GS*HR*00000003B* RECEIVER *20130924*0536*1972017*X*005010X212~
ST*276*1973007*005010X212~
BHT*0010*13*406ba0b7-700d-4c99-8c75-6da5adaf1da4*20130924*0536~
HL*1**20*1~
NM1*PR*2*SFHP*****PI* RECEIVER~
HL*2*1*21*1~
NM1*41*1*A GOOD HOSPITAL*****46*1234567890~
HL*3*2*19*1~
NM1*1P*1*THE HOSPITAL*****XX*9876543210~
HL*4*3*22*0~ DMG*D8*19980510*F~
NM1*IL*1*DOE*JANE****MI*12345678901~
TRN*1*406ba0b7-700d-4c99-8c75-6da5adaf1da4~
REF*EJ*61157208-000~
AMT*T3*1090.00~
DTP*472*RD8*20130819-20130819~
SE*16*1973007~
GE*1*1972017~
IEA*1*001972007~
277 Sample Response
ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *130924*0936*^*00501*000039422*0*P*~
GS*HN* SENDER *00000003B*20130924*0936*39421*X*005010X212~
ST*277*0001*005010X212~
BHT*0010*08*277005010X212E2*20130924*0536*DG~
HL*1**20*1~
NM1*PR*2*SAN FRANCISCO HEALTH PLAN*****PI*170558746~
PER*IC*EDI OPERATIONS*TE*8888808699*EX*4042*FX*6179235555~
HL*2*1*21*1~
NM1*41*1 A GOOD HOSPITAL *****46*1234567890~
HL*3*2*19*1~
NM1*1P*1*THE HOSPITAL*****XX*9876543210~
HL*4*3*22*0~
NM1*IL*1*DOE*JANE****MI*12345678901~
TRN*2*406ba0b7-700d-4c99-8c75-6da5adaf1da4~
STC*F1~65*20130924**1090*20.08*20130902**20130902*619524~
REF*1K*3239A7MW~
REF*EJ*61157208-000~
DTP*472*RD8*20130819-20130819~
SVC*HC~36415*25*0****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SVC*HC~80051*96*0****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SVC*HC~80076*101*0****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SVC*HC~82565*58*0****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SVC*HC~82947*66*0****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SVC*HC~84520*58*0****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SVC*HC~85025*92*20.08****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SVC*HC~85652*50*0****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SVC*HC~74020*544*0****1~
STC*P1~104*20130924~
DTP*472*RD8*20130819-20130819~
SE*44*0001~
GE*1*39421~
IEA*1*000039422~
San Francisco Health Plan is committed to providing its participating providers with the best tools possible to support their administrative needs. It is now providing electronic transactions that are compliant with the Council for Affordable Quality Health Care (CAQH) Committee on Operating Rules for Information Exchange (CORE) Operating Rules. San Francisco Health Plan is a Phase III CORE Certified Health Plan.