Back to Pilotfish Home

EDI 276 A1 Format Example

EDI 276 A1 Healthcare Claim Status Request


What is the EDI 276 Transaction Set?

The EDI 276 transaction set and format has been specified by HIPAA 5010 standards for the electronic exchange of the transmission of claims status requests. Health providers use it to verify the status of a claim submitted previously to a payer (e.g., insurance company, HMO, government agencies such as Medicare or Medicaid, etc.). Submitting a 276 status request to the payer is a step in the claim status request/response process.

The payer provides the requested information in response to the 276 Claim Status Inquiry request using the 277 Claim Status Response transaction set.  An immediate 999 Receipt Acknowledgement may be sent first while the 277 response follows. Volumes of claim information may be processed with the 276/277 transaction set pair efficiently while meeting HIPAA 5010 requirements.

The EDI 276 A1 transaction set is used by a provider, recipient of healthcare products or services, or their authorized third-party agent to request the status of a healthcare claim or encounter from a healthcare payer.

Note: EDI 276 A1 does not replace the EDI 837 Healthcare Claim transaction set but is intended for use after the receipt of a claim or encounter information. Such a request may occur at the summary or service line detail level.

EDI 276 A1 Transaction Loaded Into Healthcare Data Mapping Software

 

EDI 276 A1 Format Example
276 Request Transmission

ASC X12 Version: 005010 | Transaction Set: 276/277 | TR3 ID: 005010X212

The following is a 276 transmission XYZ Services sent to ABC Insurance requesting the status of a set of claims.

Transmission Explanation

ST*276*0001*005010X212~
BHT*0010*13*ABC276XXX*20050915*1425~
HL*1**20*1~
NM1*PR*2*ABC INSURANCE*****PI*12345~
HL*2*1*21*1~
NM1*41*2*XYZ SERVICE*****46*X67E~
HL*3*2*19*1~
NM1*1P*2*HOME HOSPITAL*****XX*1666666661~
HL*4*3*22*0~
DMG*D8*19301210*M~
NM1*IL*1*SMITH*FRED****MI*123456789A~
TRN*1*ABCXYZ1~
REF*BLT*111~
REF*EJ*SM123456~
AMT*T3*8513.88~
DTP*472*RD8*20050831-20050906~
HL*5*3*22*0~
DMG*D8*19301115*F~
NM1*IL*1*JONES*MARY****MI*234567890A~
TRN*1*ABCXYZ2~
REF*BLT*111~
REF*EJ*JO234567~
AMT*T3*7599~
DTP*472*RD8*20050731-20050809~
HL*6*2*19*1~
NM1*1P*2*HOME HOSPITAL PHYSICIANS*****XX*1666666666~
HL*7*6*22*1~
NM1*IL*1*MANN*JOHN****MI*345678901~
HL*8*7*23~
DMG*D8*19951101*M~
NM1*QC*1*MANN*JOSEPH~
TRN*1*ABCXYZ3~
REF*EJ*MA345678~
SVC*HC:99203*150*****1~
DTP*472*D8*20050501~
SE*36*0001~

Source

Accredited Standards Committee X12. ASC X12 Standard [Table Data]. Data Interchange Standards Association, Inc., McLean, VA. ASC X12 Examples

HL7 is the registered trademark of Health Level Seven International. X12, chartered by the American National Standards Institute for more than 35 years, develops and maintains EDI standards and XML schemas.

This is a unique website which will require a more modern browser to work! Please upgrade today!