276 Health Care Claim Status Request

Functional Group HR

X12N Insurance Subcommittee

This X12 Transaction Set 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.

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Heading

Position

Segment

Name

Max use

0100Transaction Set HeaderMandatory->Max 1

To indicate the start of a transaction set and to assign a control number

0200Beginning 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

0300Reference InformationOptional->Max 10

To specify identifying information

1000 Loop Optional

Repeat >1

0400Individual or Organizational NameMandatory->Max 1

To supply the full name of an individual or organizational entity

0500Additional Name InformationOptional->Max 2

To specify additional names

0600Party LocationOptional->Max 2

To specify the location of the named party

0700Geographic LocationOptional->Max 1

To specify the geographic place of the named party

0800Reference InformationOptional->Max 2

To specify identifying information

0900Administrative 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 Mandatory

Repeat >1

0100Hierarchical LevelMandatory->Max 1

To identify dependencies among and the content of hierarchically related groups of data segments

0200Subscriber 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.

0300Patient InformationOptional->Max 1

To supply patient information

The PAT segment may only appear at the Dependent (HL03=23) level.

0400Demographic 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 Optional

Repeat >1

0500Individual or Organizational NameMandatory->Max 1

To supply the full name of an individual or organizational entity

0600Party LocationOptional->Max 2

To specify the location of the named party

0700Geographic LocationOptional->Max 1

To specify the geographic place of the named party

0800Administrative Communications ContactOptional->Max 3

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

0850Reference InformationOptional->Max 9

To specify identifying information

2200 Loop Optional

Repeat >1

0900TraceMandatory->Max 1

To uniquely identify a transaction to an application

1000Reference InformationOptional->Max 9

To specify identifying information

1100Monetary Amount InformationOptional->Max 1

To indicate the total monetary amount

1200Date or Time or PeriodOptional->Max 5

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

2210 Loop Optional

Repeat >1

1300Service InformationMandatory->Max 1

To supply payment and control information to a provider for a particular service

1400Reference InformationOptional->Max 9

To specify identifying information

1500Date or Time or PeriodOptional->Max 1

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

1550Tooth IdentificationOptional->Max >1

To identify a tooth by number and, if applicable, one or more tooth surfaces

1600Transaction 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)