EDI 277 X212 - Status Request Response

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.

Heading

Position
Segment
Name
Max use
  1. To indicate the start of a transaction set and to assign a control number

  2. 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

Detail

Position
Segment
Name
Max use
  1. 2000A Loop Mandatory
    Repeat >1
    1. To identify dependencies among and the content of hierarchically related groups of data segments

      This entity is the payer who has the current status information for the specified claims.
    2. 2100A Loop Mandatory
      Repeat 1
      1. To supply the full name of an individual or organizational entity

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

        Required when the payer's contact information is not otherwise specified in a Trading Partner Agreement and the Information Receiver does not know how to contact the payer. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.
        When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number should always include the area code and phone number using the format AAABBBCCCC. A telephone extension, when applicable is reported in the communication number immediately after the telephone number.
    3. 2000B Loop Mandatory
      Repeat >1
      1. To identify dependencies among and the content of hierarchically related groups of data segments

        This entity expects a response from the Information Source. See Section 1.4.1 Transaction Participants for more information on the Information Receiver.
      2. 2100B Loop Mandatory
        Repeat 1
        1. To supply the full name of an individual or organizational entity

          This is the individual or organization requesting to receive the status information.;
      3. 2200B Loop Optional
        Repeat 1
        1. To uniquely identify a transaction to an application

          Required when rejecting claim status requests for errors at Information Source or Information Receiver levels. If not required by this implementation guide, do not send.
          If reporting error status at this level, 2000C, 2000D and 2000E Loops are not used.
        2. To report the status, required action, and paid information of a claim or service line

          See Section 1.4.3 - Status Information (STC) Segment Usage for specific STC segment information related to the hierarchical level, composites and code use.
      4. 2000C Loop Optional
        Repeat >1
        1. To identify dependencies among and the content of hierarchically related groups of data segments

          Required when status was not reported at the Information Receiver level. If not required by this implementation guide, do not send.
          This entity delivered the health care service. See Section 1.4.1 Transaction Participants for more information on the Provider.
        2. 2100C Loop Mandatory
          Repeat 2
          1. To supply the full name of an individual or organizational entity

            During the transition to NPI, for those health care providers covered under the NPI mandate, two iterations of the 2100C Loop may be sent to accommodate reporting dual provider identification numbers (NPI and Legacy). When two iterations are reported, the NPI number will be in the iteration where the NM108 qualifier will be 'XX' and the legacy number will be in the iteration where the NM108 qualifier will be either 'SV' or 'FI'.
            After the transition to NPI, for those health care providers covered under the NPI mandate, only one iteration of the 2100C loop may be sent with the NPI reported in the NM109 and NM108=XX.
        3. 2200C Loop Optional
          Repeat 1
          1. To uniquely identify a transaction to an application

            Required when rejecting the claim status request(s) for errors at the provider level. If not required by this implementation guide, do not send.
            If reporting error status at this level, the 2000D and 2000E Loops related to this provider are not used.
            The TRN Segment is syntactically required in order to use the Loop 2200C STC. TRN02 can be either a default value of zero (0) or any value the Information Source chooses to assign.
          2. To report the status, required action, and paid information of a claim or service line

            See Section 1.4.3 - Status Information (STC) Segment Usage for specific STC segment information related to the hierarchical level, composites and code use.
        4. 2000D Loop Optional
          Repeat >1
          1. To identify dependencies among and the content of hierarchically related groups of data segments

            When the patient is the subscriber or a dependent with a unique identification number, the claim status response information is reflected in the 2200D Loop under the Subscriber HL, 2000D Loop (HL03 = 22). The Dependent HL, 2000E Loop is not used. See Section 1.4.1.1 for more information on defining the patient.
            Required when the patient is the subscriber or a dependent with a unique identification number and status was not reported at the Provider level. If not required by this implementation guide, do not send.
            When requesting and responding to claim status for both a subscriber and a dependent of that subscriber, the Subscriber HL Loop 2000D must be followed by the subscriber's claim status data, Loop 2200D. In this instance, HL04=0 would be used. Then the Subscriber HL Loop 2000D must be repeated prior to the dependent HL Loop 2000E and their corresponding claim status data, Loop 2200E. In this instance, HL04=1 would be used. See Section 1.4.2.3 for an example of this structure.
          2. 2100D Loop Mandatory
            Repeat 1
            1. To supply the full name of an individual or organizational entity

          3. 2200D Loop Optional
            Repeat >1
            1. To uniquely identify a transaction to an application

              This is the trace or reference number from the originator of the transaction that was provided for this patient's 276 request.
              Required when the patient is the subscriber or a dependent with a unique identification number. If not required by this implementation guide, do not send.
              When the patient is not the subscriber or a dependent with a unique identification number, the Loop 2200E TRN and subsequent segments will be used to reflect the claim status information.
            2. To report the status, required action, and paid information of a claim or service line

              See Section 1.4.3 - Status Information (STC) Segment Usage for specific STC segment information related to the hierarchical level, composites and code use.
            3. To specify identifying information

              Required when a claim is located in the Information Source's system. If not required by this implementation guide, do not send.
              This is the payer's assigned control number, also known as, Internal Control Number (ICN), Document Control Number (DCN), or Claim Control Number (CCN).
            4. To specify identifying information

              Required on institutional claims when different than the value submitted on the 276 request. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
            5. To specify identifying information

              Required when the Patient Control Number was submitted on the 276 request or when available on claims located in the Information Source's system. If not required by this implementation guide, do not send.
              The maximum number of characters supported for the Patient Control Number is `20'.
            6. To specify identifying information

              Required when the Pharmacy Prescription Number was submitted on the 276 request or when available on claims located in the Information Source's system. If not required by this implementation guide, do not send.
            7. To specify identifying information

              Required when a voucher identifier is associated with the response claim. If not required by this implementation guide, do not send.
              Some payers assign voucher identifiers to a group of claims as part of the payment process prior to payment being issued.
            8. To specify identifying information

              Required when received on the 276 status request. If not required by this implementation guide, do not send.
            9. To specify any or all of a date, a time, or a time period

              For professional claims, this date is derived from the service level dates.
              When reporting a claim level date, use the date from the Information Source's system for claim matches, otherwise return the date from the 276 status request.
              Required for institutional claims or for professional and dental claims when the service line date is not used. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
            10. 2220D Loop Optional
              Repeat >1
              1. To supply payment and control information to a provider for a particular service

                Required when reporting status for Service Lines. If not required by this implementation guide, do not send.
                For Institutional claims, when both an NUBC revenue code and a HCPCS or HIPPS code are reported, the HCPCS or HIPPS code is reported in SVC01-2 and the revenue code is reported in SVC04. When only a revenue code is used, it is reported in SVC01-2.
              2. To report the status, required action, and paid information of a claim or service line

                See Section 1.4.3 - Status Information (STC) Segment Usage for specific STC segment information related to the hierarchical level, composites and code use.
              3. To specify identifying information

                Required when the Service Line Item Identification was submitted on the 276 request and service level status is reported. If not required by this implementation guide, do not send.
              4. To specify any or all of a date, a time, or a time period

          4. 2000E Loop Optional
            Repeat >1
            1. To identify dependencies among and the content of hierarchically related groups of data segments

              When the patient is a dependent, the claim status response information is reflected in the 2200E Loop under the Dependent HL, 2000E Loop (HL03 = 23). See Section 1.4.1.1 for more information on defining the patient.
              Required when the patient is a dependent who does not have a unique identification number. If not required by this implementation guide, do not send.
            2. 2100E Loop Mandatory
              Repeat 1
              1. To supply the full name of an individual or organizational entity

            3. 2200E Loop Mandatory
              Repeat >1
              1. To uniquely identify a transaction to an application

                This is the trace or reference number from the originator of the transaction that was provided for this patient's 276 request.
              2. To report the status, required action, and paid information of a claim or service line

                See Section 1.4.3 - Status Information (STC) Segment Usage for specific STC segment information related to the hierarchical level, composites and code use.
              3. To specify identifying information

                Required when a claim is located in the Information Source's system. If not required by this implementation guide, do not send.
                This is the payer's assigned control number, also known as, Internal Control Number (ICN), Document Control Number (DCN), or Claim Control Number (CCN).
              4. To specify identifying information

                Required on institutional claims when different than the value submitted on the 276 request. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
              5. To specify identifying information

                Required when the Patient Control Number was submitted on the 276 request or when available on claims located in the Information Source's system. If not required by this implementation guide, do not send.
                The maximum number of characters supported for the Patient Control Number is `20'.
              6. To specify identifying information

                Required when the Pharmacy Prescription Number was submitted on the 276 request or when available on claims located in the Information Source's system. If not required by this implementation guide, do not send.
              7. To specify identifying information

                Required when a voucher identifier is associated with the response claim. If not required by this implementation guide, do not send.
                Some payers assign voucher identifiers to a group of claims as part of the payment process prior to payment being issued.
              8. To specify identifying information

                Required when received on the 276 status request. If not required by this implementation guide, do not send.
              9. To specify any or all of a date, a time, or a time period

                For professional claims, this date is derived from the service level dates.
                When reporting a claim level date, use the date from the Information Source's system for claim matches, otherwise return the date from the 276 status request.
                Required for institutional claims or for professional and dental claims when the service line date is not used. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
              10. 2220E Loop Optional
                Repeat >1
                1. To supply payment and control information to a provider for a particular service

                  Required when reporting status for Service Lines. If not required by this implementation guide, do not send.
                  For Institutional claims, when both an NUBC revenue code and a HCPCS or HIPPS code are reported, the HCPCS or HIPPS code is reported in SVC01-2 and the revenue code is reported in SVC04. When only a revenue code is used, it is reported in SVC01-2.
                2. To report the status, required action, and paid information of a claim or service line

                  See Section 1.4.3 - Status Information (STC) Segment Usage for specific STC segment information related to the hierarchical level, composites and code use.
                3. To specify identifying information

                  Required when the Service Line Item Identification was submitted on the 276 request and service level status is reported. If not required by this implementation guide, do not send.
                4. To specify any or all of a date, a time, or a time period

  2. 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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