276 - Health Care Claim Status Request

FUNCTIONAL GROUP=HR

This X12 Transaction Set contains the format and establishes the data contents of the Health Care Claim Status Request Transaction Set (276) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used by a provider, recipient of health care products or services, or their authorized agent to request the status of a health care claim or encounter from a health care payer. This transaction set is not intended to replace the Health Care Claim Transaction Set (837), but rather to occur after the receipt of a claim or encounter information. The request may occur at the summary or service line detail level.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BHT	Beginning of Hierarchical Transaction	0200
REF	Reference Information	0300

1000

Segment	Name	Position
NM1	Individual or Organizational Name	0400
N2	Additional Name Information	0500
N3	Party Location	0600
N4	Geographic Location	0700
REF	Reference Information	0800
PER	Administrative Communications Contact	0900

2000

Segment	Name	Position
HL	Hierarchical Level	0100
SBR	Subscriber Information	0200
PAT	Patient Information	0300
DMG	Demographic Information	0400

2100

Segment	Name	Position
NM1	Individual or Organizational Name	0500
N3	Party Location	0600
N4	Geographic Location	0700
PER	Administrative Communications Contact	0800

2200

Segment	Name	Position
TRN	Trace	0900
REF	Reference Information	1000
AMT	Monetary Amount Information	1100
DTP	Date or Time or Period	1200

2210

Segment	Name	Position
SVC	Service Information	1300
REF	Reference Information	1400
DTP	Date or Time or Period	1500
TOO	Tooth Identification	1550
SE	Transaction Set Trailer	1600

COMMENTS

Notes
2/0200	The SBR segment may only appear at the Subscriber (HL03=22) level.
2/0300	The PAT segment may only appear at the Dependent (HL03=23) level.
2/0400	The DMG segment may only appear at the Subscriber (HL03=22) or Dependent (HL03=23) level.

rev 02/12/2024