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 a claim after it has been sent to a payer.
The 276 Health Care Claim Status Inquiry can be used by a provider to request status of a claim. Key elements used: provider number, patient identifier, dates of services and charges. The 277 Health Care Claim Status Response: 1) Payer can issue a 277 as a response to a 276 request; 2) Payer can request additional info about a submitted claim, without a 276. 3) Payer can submit an Unsolicited 277 Claim Status Response. It provides the status of the claim without a 276.
Once UnitedHealthcare EDI returns an acknowledgment that a claim has been accepted, it should be available for query as a Claim Status search. Health care professionals can perform claim status transactions in batch or real-time mode. It will be based on the connectivity method.
Claim status transactions may result in the following benefits:
- Increased efficiency
- Less time spent on manual tasks
- Decreased duplicate claim submissions
- Improved cash flow
- Available for participating and non-participating health care professionals.
The 276-277 transactions are useful to large institutions. Still they can be cost effective even for small/medium sized healthcare organizations or for payers.
To get started with EDI, contact your software vendor or clearinghouse. Claim status transactions may be integrated into your Practice Management System or Hospital Information System. This allows systems to automatically generate an inquiry. Also this allows to enable automatic posting of the status information to patient accounts. Many vendors offer multi-payer, web-based batch or real-time claim status solutions for UnitedHealthcare EDI.