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The Claim Status API supports the X12 EDI 276 transaction. It translates this standard to JSON for developer accessibility and integration into users’ applications.

The claim submitter uses a Claim Status request to ask about the status of a previously submitted claim. The payer returns the response as an X12 EDI 277 transaction, which is translated back to JSON by the API gateway. It describes where the claim is in the adjudication process (for example, Pending or Finalized).

If the claim is finalized, the response provides the disposition of the claim (for example, Paid, or Denied). For denied or rejected outcomes, the response includes the reasons for the denial or rejection.

You won't be able to obtain the claim response file itself; this file details the payments for each line item for the claim. To do that, use Claims Responses and Reports API. It works as a complement to the Claim Status API.

We also provide EDI-to-JSON mapping documentation, so you can quickly find out the EDI segments and loops that map to each JSON attribute in the API.

Release NotesFAQ
View the API Release Notes for information about the history of programmatic updates for the Claim Status API.Check out our Claim Status API FAQ for help with specific questions about this API!



Please see the API FAQs section for tips and solutions to some of the most common questions asked by customers, developer community, and internal staff about the use of our APIs.