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HIPAA SIMPLIFIED

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Claim Status

The ASC X12N Health Care Claim Status Request and Response (276/277) is a paired transaction set consisting of a Request (276) and a Response (277). 

The Request is used by the submitter of the claim to determine the status of a claim previously submitted. The Response is returned by the payer and the information provided indicates where the claim is in the adjudication process (for example, pending, finalized) and if finalized, the disposition of the claim (for example, paid, denied).  For denied or rejected, the reason for the denial or rejection is included.

Depending on how the payer or other entity adjudicates claims, the Response can report the status of individual services submitted in the claim.

  • Claim Status

    • Standards

      Current Standard

      The current mandated version of the ASC X12N Health Care Claim Status Request and Response (276/277) is 5010.

      The Technical Report Type 3 ASC X12N/005010X212 Health Care Claim Status Request and Response (276/277) can be purchased at the ASC X12 Store

      Anticipated Standard

      The next anticipated version of the ASC X12N Health Care Claim Status Request and Response (276/277) is 7030. This TR3 will be available for public review and comment from October 1 through November 30, 2016.

      Online ASC X12 Public Review Forum

    • Claim Status Companion Guides

    • Operating Rules

      Regulation

      The ASC X12N Health Care Claim Status Request and Response (276/277) is subject to the Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions; Interim Final Rule adopted by the Department of Health and Human Services on July 8, 2011.

      Voluntary Certification

      CAQH CORE offers a voluntary certification program for their Claim Status (Phase II) Operating Rules.

      Eligibility / Claims Status Operating Rules