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Transaction Set
in
X12 Release 004030

277 Health Care Claim Status Notification

Functional Group HN

This Draft Standard for Trial Use contains the format and establishes the data contents of the Health Care Claim 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. 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

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
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
Status InformationMandatory
Max >1
To report the status, required action, and paid information of a claim or service line
1100
Reference Identification
Max 3
To specify identifying information
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
Paperwork
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 Contact
Max 1
To identify a person or office to whom administrative communications should be directed
1500
Name
Max 1
To identify a party by type of organization, name, and code
1600
Address Information
Max 1
To specify the location of the named party
1700
Geographic Location
Max 1
To specify the geographic place of the named party
2220 Loop
Repeat >1
1800
Service Information
Max 1
To supply payment and control information to a provider for a particular service
1900
Status InformationMandatory
Max >1
To report the status, required action, and paid information of a claim or service line
2000
Reference Identification
Max 1
To specify identifying information
2100
Date or Time or Period
Max 1
To specify any or all of a date, a time, or a time period
2225 Loop
Repeat >1
2200
Paperwork
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 Contact
Max 1
To identify a person or office to whom administrative communications should be directed
2400
Name
Max 1
To identify a party by type of organization, name, and code
2500
Address Information
Max 1
To specify the location of the named party
2600
Geographic Location
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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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.