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.
Heading
Sequence
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 Information
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
0500
Additional Name Information
Max 2
To specify additional names
0600
Party Location
Max 2
To specify the location of the named party
0700
Geographic Location
Max 1
To specify the geographic place of the named party
0800
Reference Information
Max 2
To specify identifying information
0900
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be
directed
Detail
Sequence
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 Information
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 Information
Max 1
To supply patient information
The PAT segment may only appear at the Dependent (HL03=23) level.
0400
Demographic Information
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 Location
Max 2
To specify the location of the named party
0700
Geographic Location
Max 1
To specify the geographic place of the named party
0800
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be
directed
0850
Reference Information
Max 9
To specify identifying information
2200 Loop
Repeat >1
0900
TraceMandatory
Max 1
To uniquely identify a transaction to an application
1000
Reference Information
Max 9
To specify identifying information
1100
Monetary Amount Information
Max 1
To indicate the total monetary amount
1200
Date or Time or Period
Max 5
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 Information
Max 9
To specify identifying information
1500
Date or Time or Period
Max 1
To specify any or all of a date, a time, or a time period
1550
Tooth Identification
Max >1
To identify a tooth by number and, if applicable, one or more tooth surfaces
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)