Business Usage Health Care Claim Status Request and Response (276/277)

The ASC X12 Health Care Claim Status Request and Response (276/277) implementation
guide addresses the paired usage of the 276 as a request for claim status and the
277 as a response to that request. The 276 is used to transmit request(s) to obtain
the status of specific health care claim(s) within a payer's adjudication process. The
payer uses the 277 to transmit the current system status of those requested claims.
Claim history parameters may vary by payers and systems.
Status information can be requested and responded to at the claim and/or service level.
The 276 provides information that is necessary for the payer to identify the specific
claim(s) in question. Some primary or unique identifying element(s) may be supplied to
obtain an exact match for that request. However, when the 276 does not uniquely identify
the claim within the payer's system, the response may include multiple claims that meet
the parameters supplied by the requester.
Figure 1.1 - Information Flow for Claim Status Request/Response, illustrates the flow of
information for the 276 Health Care Claim Status Request and the 277 Health Care
Claim Status Response.
Figure 1.1 - Information Flow for Claim Status Request/Response