X12 276/277 Transactions In CAQH CORE 250: Claim Status Rule X12 276/277 Transactions can be tracked throughout a system/application to demonstrate conformance with the response time requirements specified in the CAQH CORE 250 Rule. CAQH CORE 250: Claim Status Rule requires HIPAA covered entities to capture, log, audit, match, and report the date, time, and control Read More →

276/277 HIPAA Transaction Notes (Washington State Health Care Authority) 276/277 HIPAA transaction guides state that when the trading partner submits the 276 request by any one of the specified methods the 276 request will be validated using EDI validator (up to levels HIPAA validation level 1 & 2), translated and will be processed. The positive Read More →

Claim Status Request and Response CMS Guidelines Claim Status Request and Response: Providers have a number of options to obtain claim status Information from Medicare Administrative Contractors (MACs): Providers can enter data via the Interactive Voice Response (IVR) telephone systems operated by the MACs. Providers can submit claim status inquiries via the Medicare Administrative Contractors’ provider Read More →

276, 277 EDI transactions details 276, 277 EDI transactions examples are presented below for better understanding of the transaction sets. 276, 277 EDI transactions purposes: the 276 transaction is designed to be exchanged for a 277 response containing the benefit information sought in the 276 request. Should the 276 fail structural validation upon receipt, a 999 Read More →

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, Read More →

EDI 5010 Version Changes EDI 5010 recent updates can influence correspondence in healthcare claims exchange and flow between partners. It is recommended that both parties take part in EDI 5010 updates testing procedures in order to prevent delays or issues in processing your claims cycle. EDI 4010 to EDI 5010 basis The centers for Medicare and Read More →

UnitedHealthcare EDI requirements for Claim Status Inquiry & Response Transactions UnitedHealthcare EDI 276 transaction (Health Care Claim Status Inquiry) is used to inquire about the status of a claim after it has been sent to a payer. UnitedHealthcare EDI 277 transaction (Health Care Claim Status Response) is used to respond to a request inquiry about the status of Read More →