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Transaction Set
in
X12 Release 004030

276 Health Care Claim Status Request

Functional Group HR

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

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 Identification
Max 10
To specify identifying information
1000 Loop
Repeat >1
0400
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
0500
Additional Name Information
Max 2
To specify additional names
0600
Address Information
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 Identification
Max 2
To specify identifying information
0900
Administrative Communications Contact
Max 1
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 Name
Max 1
To supply the full name of an individual or organizational entity
0600
Address Information
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 1
To identify a person or office to whom administrative communications should be directed
2200 Loop
Repeat >1
0900
Trace
Max 1
To uniquely identify a transaction to an application
1000
Reference Identification
Max 3
To specify identifying information
1100
Monetary Amount
Max 1
To indicate the total monetary amount
1200
Date or Time or Period
Max 2
To specify any or all of a date, a time, or a time period
2210 Loop
Repeat >1
1300
Service Information
Max 1
To supply payment and control information to a provider for a particular service
1400
Reference Identification
Max 1
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
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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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.