Check claim status

You may need to check the status of a claim if you don’t receive a 277CA or 835 ERA response from the payer within your expected timeframe. You may also want to check the status of a claim submitted by another entity. For example, a billing agency may want to check the status of a claim submitted by their customer, who is a provider.

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Claim Status API

Call one of the following endpoints to send a 276 Claim Status Request:

• Claim Status to send requests in JSON
• Claim Status Raw X12 to send requests in X12 EDI

The endpoint returns a synchronous claim status response from the payer in JSON format. The response may contain information about more than one claim, if the payer has multiple claims on file that match the information you provided.

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Date range

We recommend supplying a date range that is at least plus or minus 7 days from the date of the services listed in the claim. The payer may have stored a different date for the encounter than the one in your records, so providing a date range increases the likelihood that the payer will find a match.

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Character restrictions

Only use the X12 Basic and Extended character sets in request data. Using characters outside these sets may cause validation and HTTP 400 errors.

In addition, the following characters are reserved for delimiters in the final X12 EDI transaction to the payer: ~, *, :, and ^. X12 doesn’t support using escape sequences to represent delimiters or special characters. Stedi returns a 400 error if you use these restricted characters improperly.

• JSON endpoint: Don’t include delimiter characters anywhere in your request data.
• Raw X12 endpoint: You can use these characters as delimiters, but not in the body of the request data.

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Sample requests and responses

The following examples show a claim status request and response for Stedi’s JSON API.

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Accepted claim

The following example shows a claim status request and response for a claim that has been accepted by the payer and is awaiting payment.

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Denied claim

The following example shows a claim status request and response for a claim that has been denied by the payer. Note that in this example, the subscriber in the request is actually a dependent using the subscriber’s member ID.

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Code lists

You may need to reference the following code lists when working with the claim status request or response.

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Claim status category

Visit Claim Status Category Codes in the official X12 documentation for a complete list.

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Product or service ID qualifier

Used in the serviceLineInformation.productOrServiceIDQualifier request property and the claims.serviceDetails.service.serviceIdQualifierCode property in the response.