x12 277 Health Care Information Status Notification

277 Specifications

The EDI 277 Health Care Claim Status Response transaction set is used by healthcare payers (insurance companies, Medicare, etc.) to report on the status of claims (837 transactions) previously submitted by providers.

The 277 transaction, which has been specified by HIPAA for the submission of claim status information, can be used in one of the following three ways:

⇰ A 277 transaction may be sent in response to a previously received EDI 276 Claim Status Inquiry
⇰ A payer may use a 277 to request additional information about a submitted claim (without a 276)
⇰ A payer may provide claim status information to a provider using the 277, without receiving a 276

Information provided in a 277 transaction generally indicates where the claim is in process, either as Pending or Finalized. If finalized, the transaction indicates the disposition of the claim – rejected, denied, approved for payment or paid.

If the claim was approved or paid, payment information may also be provided in the 277, such as method, date, amount, etc. If the claim has been denied or rejected, the transaction may include an explanation, such as if the patient is not eligible.

277 Example

ISA*00* *00* *01*1234567890 *01*999999999 *120126*1211*U*00401*000000632*0*P~
GS*ME*1234567890 *999999999 *20120126*1211*1*T*004010~
ST*277*0001~
BHT*0001*00*Reference Identification**1744480~
REF*01*Reference Identification*Description*01\Reference Identification\01\Reference Identification~
HL*1**1~
DMG*CC*Date Time Period*A***1~
NM1*01*1*Name Last or Organization Name**Name Middle*Name Prefi****01*01~
N4*City Name**POSTAL CODE*COU~
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe~
TRN*1*Reference Identification~
STC*Industry Code\Industry Code\01**1*10548281732963524**20120314*****Industry Code\Industry Code~
REF*01*Reference Identification**01\Reference Identification\\\01\Reference Identification~
DTP*001*CC*Date Time Period~
SE*13*0001~
GE*1*1~
IEA*1*000000632~


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