Response Contents

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

Claim Status responses provide full breakdowns of all the line items in the claim.

Each line item, in a professional claim for example, is represented in a serviceLine record within the claim. Claim Status lists the end-result payoffs for each submitted serviceLine in a claimStatus object. This applies for both Professional claims and Institutional claims.

The sandbox version of the API shows a list of several such claimStatus objects as follows. Each object contains a series of codes and code explanations that originate from the payer system. They follow the industry standards in the EDI 277 response: Claim Status Request & Response. To troubleshoot, see Troubleshoot APIs with Metadata.

Understanding Specific Attributes and Objects

Most Claim Status 277 responses will contain a header with several attributes. It includes the originating controlNumber under which the originating claim request was made; the tradingartnerServiceId Payer ID; and other payer identification.

The providers object lists each of the providers involved in the claim submission. This will include the billing provider.

The claimStatus object contains the key Claim Status content. As you can see above, you can have multiple instances of this object in a single claim. It consists of the following attributes:

Attribute Name	Values
`statusCategoryCode`	Code value showing the status of the claim with a two-digit alphanumeric value. Characteristic values: `F1` indicates the service line for the claim is paid; `F3` indicates the claim is adjusted and final; `A4` indicates that the specified claim service line does not exist in the payer system.
`statusCategoryCodeValue`	Plain-language description of the status of the claim.
`statusCode`	The Valid Claim Status code. Usually will show a value of `101`, stating it's a valid claim.
`statusCodeValue`	Provides more information about how the claim was processed.
`entityCode`	The code identifying the entity type associated with the service line. `1E` - HMO; `2P` - Public Health Service Facility;
`entity`	Non-code description of the entity type.
`effectiveDate`	Date the claim line item was placed in its current status by the payer's adjudication process.
`submittedAmount`	Total amount billed for the service line.
`amountPaid`	Amount the payer agreed to pay. The remainder from this will be the patient's responsibility.
`paidDate`	Date of denial or approval of the claim service line.
`checkIssueDate`, `checkNumber`	Paper check or EFT funds available date and trace number.
`claimServiceDate`	Date or date range of the medical service. Format YYYYMMDD.
`tradingPartnerClaimNumber`	The payer's assigned control number.

You can look up the entire statusCategoryCode table and its associated statusCategoryCodeValue table in the X12 EDI standards page. Some coding information is accessible only through copyrighted subscription and hence can't be fully described here.

Updated 8 months ago