X12 276/277 Transactions

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 numbers from their own internal systems, and corresponding data received from their trading partners. The auditing requirement is included so that each entity will have the log of data to be used to resolve any issues or concerns. For the 20-second maximum real time response requirement, this log could also be used to identify where a bottleneck may be occurring.

Section 4.3.4 of the CAQH CORE 270: Connectivity Rule also specifies that, to comply with the CAQH CORE 250 Rule, message receivers will be required to track the times of any received inbound messages, and respond with the outbound message for that payload ID. Additionally, message senders must include the CORE Envelope Metadata element Time Stamp (as specified in the CAQH CORE 270 Rule, Section 4.1.2).

Other data may be required for auditing purposes; however, this data can be determined by each entity. CAQH CORE recommends that, in order to uniquely identify an X12 transmission, entities store the ISA06, ISA08, ISA13, GS02, GS03, GS06, ST02, TRN02, and if sent in the transaction, the BHT03. The audit log requirement was purposefully specified at a high level in each rule to enable each entity along the transaction pathway to design and develop its own process for audit handling. Additionally, the rules do not specify how long an entity is to maintain the data for auditing purposes.

If an X12 276 is received in a batch, does the X12 277 have to be returned in a batch? The CAQH CORE Rule does not address this issue. The batch response time rule only requires that a health plan have the batch responses available by 7:00 AM the next business day following a submission of inquiries by 9:00 PM ET the previous business day. Therefore, the CAQH CORE Rule does not specify whether or not the batch of X12 277 responses must match exactly the batch of X12 276 inquiries.

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