Request Body Parameters

Use our OpenAPI spec for our EDI 276 Claim Status submission.

The Claim Status request body is a relatively brief and a straightforward piece of information as you are not submitting a claim but only inquiring after an existing one. It consists of a single instance of the following objects:

  • Standard header information (controlNumber, tradingPartnerServiceId (is the Payer ID; this will vary based on the payer you want to connect to))
  • Billing provider information (providers object)
  • Subscriber (with the optional dependent object)
  • Encounter (the doctor's visit that's the origin of the claim filing)

Different payers have different recommendations for what you must include in a request, for example, Blue Cross affiliates, such as BCBSNC require the npi (provider identifier) in EDI 276 requests, and recommends adding the Patient Account Number (in Loop 2200D, element REF01) to associate submitted requests to correct responses. See example in Claim Status Request & Response.