277 Health Care Information Status Notification

Functional Group HN

X12N Insurance Subcommittee

This X12 Transaction Set contains the format and establishes the data contents of the Health Care Information 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, health care services review, or transactions related to the provisions of health care. 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
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 InformationOptional
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
Party LocationOptional
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 InformationOptional
Max 2
To specify identifying information
0900
Administrative Communications ContactOptional
Max 3
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
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
Party LocationOptional
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 3
To identify a person or office to whom administrative communications should be directed
0850
Reference InformationOptional
Max 9
To specify identifying information
2200 Loop
Repeat >1
0900
TraceMandatory
Max 1
To uniquely identify a transaction to an application
1000
Status InformationOptional
Max >1
To report the status, required action, and paid information of a claim or service line
1100
Reference InformationOptional
Max 9
To specify identifying information
1200
Date or Time or PeriodOptional
Max 5
To specify any or all of a date, a time, or a time period
1210
Quantity InformationOptional
Max 5
To specify quantity information
1220
Monetary Amount InformationOptional
Max 5
To indicate the total monetary amount
2210 Loop
Repeat >1
1300
PaperworkMandatory
Max 1
To identify the type or transmission or both 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.
1400
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
1500
Party IdentificationOptional
Max 1
To identify a party by type of organization, name, and code
1600
Party LocationOptional
Max 1
To specify the location of the named party
1700
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
2220 Loop
Repeat >1
1800
Service InformationMandatory
Max 1
To supply payment and control information to a provider for a particular service
1900
Status InformationOptional
Max >1
To report the status, required action, and paid information of a claim or service line
2000
Reference InformationOptional
Max 9
To specify identifying information
2100
Date or Time or PeriodOptional
Max 1
To specify any or all of a date, a time, or a time period
2150
Tooth IdentificationOptional
Max >1
To identify a tooth by number and, if applicable, one or more tooth surfaces
2225 Loop
Repeat >1
2200
PaperworkMandatory
Max 1
To identify the type or transmission or both 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.
2300
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
2400
Party IdentificationOptional
Max 1
To identify a party by type of organization, name, and code
2500
Party LocationOptional
Max 1
To specify the location of the named party
2600
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
2700
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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