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.

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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

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

1000Status InformationOptional->Max >1

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

1100Reference InformationOptional->Max 9

To specify identifying information

1200Date or Time or PeriodOptional->Max 5

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

1210Quantity InformationOptional->Max 5

To specify quantity information

1220Monetary Amount InformationOptional->Max 5

To indicate the total monetary amount

2210 Loop Optional

Repeat >1

1300PaperworkMandatory->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.

1400Administrative Communications ContactOptional->Max 3

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

1500Party IdentificationOptional->Max 1

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

1600Party LocationOptional->Max 1

To specify the location of the named party

1700Geographic LocationOptional->Max 1

To specify the geographic place of the named party

2220 Loop Optional

Repeat >1

1800Service InformationMandatory->Max 1

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

1900Status InformationOptional->Max >1

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

2000Reference InformationOptional->Max 9

To specify identifying information

2100Date or Time or PeriodOptional->Max 1

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

2150Tooth IdentificationOptional->Max >1

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

2225 Loop Optional

Repeat >1

2200PaperworkMandatory->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.

2300Administrative Communications ContactOptional->Max 3

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

2400Party IdentificationOptional->Max 1

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

2500Party LocationOptional->Max 1

To specify the location of the named party

2600Geographic LocationOptional->Max 1

To specify the geographic place of the named party

2700Transaction 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)