277 Health Care Claim Status Notification

Functional Group HN

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Health Care Claim Status Notification Transaction Set (277) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used by a health care payer or authorized agent to notify a provider, recipient, or authorized agent regarding the status of a health care claim or encounter or to request additional information from the provider regarding a health care claim or encounter. This transaction set is not intended to replace the Health Care Claim Payment/Advice Transaction Set (835) and therefore, will not be used for account payment posting. The notification may be at a summary or service line detail level. The notification may be solicited or unsolicited.

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 information

  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 information

    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 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 report the status, required action, and paid information of a claim or service line

      3. To specify identifying information

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

      5. 2210 Loop Optional
        Repeat >1
        1. To identify the type and transmission of paperwork or supporting information

          The 2210 loop may be used when there is a status notification or a request for additional information about a particular claim.
        2. To identify a person or office to whom administrative communications should be directed

        3. To identify a party by type of organization, name, and code

        4. To specify the location of the named party

        5. To specify the geographic place of the named party

      6. 2220 Loop Optional
        Repeat >1
        1. To supply payment and control information to a provider for a particular service

        2. To report the status, required action, and paid information of a claim or service line

        3. To specify identifying information

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

        5. 2225 Loop Optional
          Repeat >1
          1. To identify the type and transmission of paperwork or supporting information

            The 2225 loop may be used when there is a status notification or a request for additional information about a particular service line.
          2. To identify a person or office to whom administrative communications should be directed

          3. To identify a party by type of organization, name, and code

          4. To specify the location of the named party

          5. To specify the geographic place of the named party

  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)

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