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
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning of Hierarchical TransactionMandatory
Max 1
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
0300
Reference IdentificationOptional
Max 10
To specify identifying information
1000 Loop
Repeat >1
0400
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
0600
Address InformationOptional
Max 2
To specify the location of the named party
0700
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0800
Reference IdentificationOptional
Max 2
To specify identifying information
0900
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed

Detail

Position
Segment
Name
Max use
2000 Loop
Repeat >1
0100
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
0200
Subscriber InformationOptional
Max 1
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.
0300
Patient InformationOptional
Max 1
To supply patient information
The PAT segment may only appear at the Dependent (HL03=23) level.
0400
Demographic InformationOptional
Max 1
To supply demographic information
The DMG segment may only appear at the Subscriber (HL03=22) or Dependent (HL03=23) level.
2100 Loop
Repeat >1
0500
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
0600
Address InformationOptional
Max 2
To specify the location of the named party
0700
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0800
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
2200 Loop
Repeat >1
0900
TraceMandatory
Max 1
To uniquely identify a transaction to an application
1000
Reference IdentificationOptional
Max 3
To specify identifying information
1100
Monetary AmountOptional
Max 1
To indicate the total monetary amount
1200
Date or Time or PeriodOptional
Max 2
To specify any or all of a date, a time, or a time period
2210 Loop
Repeat >1
1300
Service InformationMandatory
Max 1
To supply payment and control information to a provider for a particular service
1400
Reference IdentificationOptional
Max 1
To specify identifying information
1500
Date or Time or PeriodOptional
Max 1
To specify any or all of a date, a time, or a time period
1600
Transaction Set TrailerMandatory
Max 1
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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