Convert 277 or 835 Report
A 277 transaction is claim status response to an EDI 276 transaction. A 277 might be a solicited response or an unsolicited one, in which case you need to proactively use our API to check your mailbox for any new 277 claim responses. 277 files use the phrase X3 as the prefix in the file name for any 277 claim status response.
A 276 transaction is a request for the status of a health care claim. It is submitted by a provider, a health care/services recipient, or an authorized agent (any of these could be the consumer of our APIs).
835 responses are claims remittance notifications letting the recipient know what the payer has approved and by what percentage coverage is approved for medical services. 835 files begin with the prefix R5. These files are returned in EDI format by default. You can open such files in JSON using our /835 endpoint.
The conversion of these files provides the same data but the base endpoint will return the X12 version of the transaction and the /277 or /835 endpoint will convert the file to JSON. As these file types are already built on existing transaction, you should determine if the X12 version or the JSON version of the information is what you would prefer to work with.
Specify the Report file in the request URL, including its two-letter extension, along with the correct endpoint type. The endpoint will always be either /277 or /835.
https://sandbox-apigw.optum.com/medicalnetwork/reports/v2/{filename}/277
The file, which is available in the sandbox API implementation, is for a relatively brief single-claim 277 claim status response.
```json
{
"transactions": [
{
"controlNumber": "0001",
"referenceIdentification": "000000001",
"transactionSetCreationDate": "20201201",
"transactionSetCreationTime": "120558",
"payers": [
{
"organizationName": "PREMERA",
"payerIdentification": "430",
"claimStatusTransactions": [
{
"provider": {
"organizationName": "CHC3",
"etin": "000000000"
},
"claimStatusDetails": [
{
"serviceProvider": {
"organizationName": "HAPPY DOCTORS GROUP",
"npi": "1111111111"
},
"patientClaimStatusDetails": [
{
"subscriber": {
"lastName": "DOEONE",
"firstName": "JOHNONE",
"memberId": "0000000000"
},
"claims": [
{
"claimStatus": {
"referencedTransactionTraceNumber": "000000001",
"informationClaimStatuses": [
{
"statusInformationEffectiveDate": "20200613",
"totalClaimChargeAmount": "100",
"claimPaymentAmount": "80",
"adjudicatedFinalizedDate": "20200609",
"remittanceDate": "20200613",
"remittanceTraceNumber": "1111111",
"informationStatuses": [
{
"healthCareClaimStatusCategoryCode": "F1",
"healthCareClaimStatusCategoryCodeValue": "Finalized/Payment-The claim/line has been paid.",
"statusCode": "65",
"statusCodeValue": "Claim/line has been paid."
}
]
}
],
"tradingPartnerClaimNumber": "AAAAAAAAAAA1",
"patientAccountNumber": "00000",
"clearinghouseTraceNumber": "111111111111111",
"claimServiceBeginDate": "20200214",
"claimServiceEndDate": "20200214"
},
"serviceLines": [
{
"service": {
"serviceIdQualifierCode": "HC",
"serviceIdQualifierCodeValue": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
"procedureCode": "97161",
"procedureModifiers": [
"95"
],
"chargeAmount": "100",
"amountPaid": "80",
"submittedUnits": "1"
},
"serviceClaimStatuses": [
{
"effectiveDate": "20200613",
"serviceStatuses": [
{
"healthCareClaimStatusCategoryCode": "F1",
"healthCareClaimStatusCategoryCodeValue": "Finalized/Payment-The claim/line has been paid.",
"statusCode": "65",
"statusCodeValue": "Claim/line has been paid."
}
]
}
],
"beginServiceLineDate": "20200214",
"endServiceLineDate": "20200214"
}
]
}
]
}
]
}
]
}
]
...
```
The lengthy example is a completed record for a single claim in a multiple-claim report.
You can determine how many claims the current 277 file contains by looking for the following three JSON attributes in a group:
```json
"organizationName": "PREMERA",
"payerIdentification": "430",
"claimStatusTransactions": [
```
Each of these attributes is a complete claims entry in the transactions list.
Updated about 1 month ago