Claim Status X12 EDI 276 Request & 277 Response

Claim Status X12 EDI 276 Request Example Description

javascript POST ${api_basepath}/raw-x12 HTTP/1.1 Host: ${apigee_host} Authorization: Bearer <Your-Access-Token> Content-Type: application/json { "x12": "ISA_00_.........._01_password \_ZZ_something_ ZZ_EMDEON.........\_200729_0835_^_00501_000000001_ 0_P_:~GS_HR_LCX1210000_MTEXE_20200729_0835_000000001_ X_005010X212~ST_276_000000001_005010X212~BHT_0010_13_ 000000001_20200729_0835~HL_1\*\*20_1~NM1_PR_2\*MedWest**\*** PI_serviceId~HL_2_1_21_1~NM1_41_2_TestProvider**\***46_ 0123456789~HL_3_2_19_1~NM1_1P_2_happy doctors group**\*** XX_1760854442~HL_4_3_22_1~DMG_D8_18800102_M~NM1_IL_1_ doeone_johnone\*_\*\*MI_0000000000~HL_5_3_23_0~DMG_D8_ 18800101_F~NM1_QC_1_doeone_janeone~TRN_1_ABCD~REF_ 6P_0000000000~DTP_472_RD8_20100101-20100102~SE_18_ 000000001~GE_1_000000001~IEA_1_000000001~" } A few notes about this example in the X12 transmission payload:
The ISA, GS, and ST control segments are used as envelopes to encapsulate the medical transaction data and confidentially manage its transmission.
The GS header ends with the Version ID code (005010X212), which describes the EDI standard used in the transaction.
The ST header states the type of medical transaction, which is 276 in this example (Claim Status submission).

When the envelope headers are complete:
_ The Beginning of Hierarchical Transaction (BHT) field shows the start of the data that forms the Claim Status medical transaction.
* The end of the claim status request body carries the TRN (Claim Tracking Number) and REF (Payer Claim Control Number) segments.

Claim Status X12 EDI 276 Request Example	Description
javascript POST ${api_basepath}/raw-x12 HTTP/1.1 Host: ${apigee_host} Authorization: Bearer <Your-Access-Token> Content-Type: application/json { "x12": "ISA_00_.........._01_password \_ZZ_something_ ZZ_EMDEON.........\_200729_0835_^_00501_000000001_ 0_P_:~GS_HR_LCX1210000_MTEXE_20200729_0835_000000001_ X_005010X212~ST_276_000000001_005010X212~BHT_0010_13_ 000000001_20200729_0835~HL_1\\20_1~NM1_PR_2\MedWest\ PI_serviceId~HL_2_1_21_1~NM1_41_2_TestProvider\*46_ 0123456789~HL_3_2_19_1~NM1_1P_2_happy doctors group\*** XX_1760854442~HL_4_3_22_1~DMG_D8_18800102_M~NM1_IL_1_ doeone_johnone\_\\*MI_0000000000~HL_5_3_23_0~DMG_D8_ 18800101_F~NM1_QC_1_doeone_janeone~TRN_1_ABCD~REF_ 6P_0000000000~DTP_472_RD8_20100101-20100102~SE_18_ 000000001~GE_1_000000001~IEA_1_000000001~" }	A few notes about this example in the X12 transmission payload: The `ISA`, `GS`, and `ST` control segments are used as envelopes to encapsulate the medical transaction data and confidentially manage its transmission. The GS header ends with the Version ID code (`005010X212`), which describes the EDI standard used in the transaction. The ST header states the type of medical transaction, which is `276` in this example (Claim Status submission). When the envelope headers are complete: _ The Beginning of Hierarchical Transaction (`BHT`) field shows the start of the data that forms the Claim Status medical transaction. * The end of the claim status request body carries the `TRN` (Claim Tracking Number) and `REF` (Payer Claim Control Number) segments.

Claim Status X12 EDI 277 Response Example Description

Claim Status X12 EDI 277 Response Example	Description
`javascript POST ${apibasepath}/raw-x12 HTTP/1.1 Host: ${apigee_host} Authorization: Bearer Content-Type: application/json { "x12": "ISA_00.........01_SomePwd_ZZ_EMDEON......... ZZTPG00000_201006_1752^00501_000000001_0_T:~GS HN_MTEXE_LCX1210000_20131015_2219_000000001_X_005010X212~ST 277000000001_005010X212~BHT_0010_08_000000001_20200729 0835_DG~HL_120_1~NM1_PR_2_Unknown**PI_serviceId~ HL_2_1_21_1~NM1_41_2_TestProvider46_0123456789~ HL_3_2_19_1~NM1_1P_2_happy doctors groupXX_1760854442~ HL_4_3_22_0~NM1_IL_1_doeone_johnone***MI_0000000000~ TRN_2_000000001~ STC_F1:65:1E_201704151229_219_2017041520170415_1111111~ REF_1K_AAAAAAAAAAA1~DTP_472_D8_20160722~ TRN_2_C1234567891028297LL~ STC_F3:101:1E_201704121229_184.05~REF_1K_AAAAAAAAAAA2~ DTP_472_D8_20160722~TRN_2_C1234567891028297LL~ STC_F3:101:1E_201612011229_219~REF_1K_AAAAAAAAAAA3~ DTP_472_D8_20160722~SE_23_000000001~GE_1_000000001~ IEA_1_000000001~" }	Core claim information consists of the `STC` segments, which vary by loop based on the entities receiving the status information: Information Receiver status information Provider status information Claim Level status information ServiceLine status information Claim Level status information and service line status information can include monetary amounts. The second and third STC segments in the response above show monetary amounts of $`184.05` and $`219`. Responses may or may not provide monetary amounts, based on the current claim status. Also, payers may or may not support service line reporting. See page 138 of the ASC X12 276/277 Implementation Guide for Claim Level Status Information and page 160 for Service Lines Status Information.

`javascript
POST ${apibasepath}/raw-x12 HTTP/1.1
Host: ${apigee_host}
Authorization: Bearer
Content-Type: application/json
{
"x12": "ISA_00.........01_SomePwd_ZZ_EMDEON.........
ZZTPG00000_201006_1752^00501_000000001_0_T:~GS
HN_MTEXE_LCX1210000_20131015_2219_000000001_X_005010X212~ST
277000000001_005010X212~BHT_0010_08_000000001_20200729
0835_DG~HL_120_1~NM1_PR_2_Unknown***PI_serviceId~
HL_2_1_21_1~NM1_41_2_TestProvider*46_0123456789~
HL_3_2_19_1~NM1_1P_2_happy doctors group*XX_1760854442~
HL_4_3_22_0~NM1_IL_1_doeone_johnone****MI_0000000000~
TRN_2_000000001~
STC_F1:65:1E_201704151229_219_2017041520170415_1111111~
REF_1K_AAAAAAAAAAA1~DTP_472_D8_20160722~
TRN_2_C1234567891028297LL~
STC_F3:101:1E_201704121229_184.05~REF_1K_AAAAAAAAAAA2~
DTP_472_D8_20160722~TRN_2_C1234567891028297LL~
STC_F3:101:1E_201612011229_219~REF_1K_AAAAAAAAAAA3~
DTP_472_D8_20160722~SE_23_000000001~GE_1_000000001~
IEA_1_000000001~"
}

Core claim information consists of the STC segments, which vary by loop based on the entities receiving the status information:

Information Receiver status information
Provider status information
Claim Level status information
ServiceLine status information

Claim Level status information and service line status information can include monetary amounts.
The second and third STC segments in the response above show monetary amounts of $184.05 and $219.
Responses may or may not provide monetary amounts, based on the current claim status. Also, payers may or may not support service line reporting. See page 138 of the ASC X12 276/277 Implementation Guide for Claim Level Status Information and page 160 for Service Lines Status Information.

Updated 5 months ago