276 Health Care Claim Status Request

Functional Group HR

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Health Care Claim Status Request Transaction Set (276) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used by a provider, recipient of health care products or services, or their authorized agent to request the status of a health care claim or encounter from a health care payer. This transaction set is not intended to replace the Health Care Claim Transaction Set (837), but rather to occur after the receipt of a claim or encounter information. The request may occur at the summary or service line detail level.

Heading

Position
Segment
Name
Max use
  1. To indicate the start of a transaction set and to assign a control number

  2. To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data; i.e., number, date, and time

  3. To specify identifying numbers.

  4. 1000 Loop Optional
    Repeat >1
    1. To supply the full name of an individual or organizational entity

    2. To specify additional names or those longer than 35 characters in length

    3. To specify the location of the named party

    4. To specify the geographic place of the named party

    5. To specify identifying numbers.

    6. To identify a person or office to whom administrative communications should be directed

Detail

Position
Segment
Name
Max use
  1. 2000 Loop Mandatory
    Repeat >1
    1. To identify dependencies among and the content of hierarchically related groups of data segments.

    2. To record claim information specific to the primary insured and the insurance carrier for that insured

      The SBR segment may only appear at the Subscriber (HL03=22) level.
    3. To supply patient information

      The PAT segment may only appear at the Dependent (HL03=23) level.
    4. To supply demographic information

      The DMG segment may only appear at the Subscriber (HL03=22) or Dependent (HL03=23) level.
    5. 2100 Loop Optional
      Repeat >1
      1. To supply the full name of an individual or organizational entity

      2. To specify the location of the named party

      3. To specify the geographic place of the named party

      4. To identify a person or office to whom administrative communications should be directed

    6. 2200 Loop Optional
      Repeat >1
      1. To uniquely identify a transaction to an application.

      2. To specify identifying numbers.

      3. To indicate the total monetary amount.

      4. To specify any or all of a date, a time, or a time period

      5. 2210 Loop Optional
        Repeat >1
        1. To supply payment and control information to a provider for a particular service

        2. To specify identifying numbers.

        3. To specify any or all of a date, a time, or a time period

  2. To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments).

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference is provided for marketing purposes and is free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.