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EDI 277-A1 Format Example

EDI 277-A1 Health Care Claim Status Notification


The EDI 277-A1 is used by healthcare payer or authorized agent to notify a provider, recipient, or authorized agent. EDI 277-A1 is used regarding the status of a health care claim or encounter or to request additional information from the provider regarding a health care claim or encounter. It can also be used for a health care services review or transactions related to the provisions of health care. The notification may be solicited or unsolicited.

EDI 277-A1 does not replace the Health Care Claim Payment/Advice Transaction Set (835). It is not used for account payment posting. The notification may be at a summary or service line detail level.

EDI 277-A1 Healthcare Claim Status Notification in Data Mapping Software

The EDI 277 transaction set has been specified by HIPAA for the submission of claim status information to respond to a previously received EDI 276 Claim Status Inquiry, to request that a payer provide additional information about a submitted claim (no 276 involved), and for a payer to provide claim status information to a provider via the EDI 277, without having received a 276.

EDI 277-A1 Format Example
277 ResponseTransmission

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

The following is the 277 transmission ABC Insurance sent in response to the 276 transmission from XYZ Service for a set of claims.

Transmission Explanation

ST*277*0001*005010X212~
BHT*0010*08*277X212*20050916*0810*DG~
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~
NM1*IL*1*SMITH*FRED****MI*123456789A~
TRN*2*ABCXYZ1~
STC*P3:317*20050913**8513.88~
REF*1K*05347006051~
REF*BLT*111~
REF*EJ*SM123456~
DTP*472*RD8*20050831-20050906~
HL*5*3*22*0~
NM1*IL*1*JONES*MARY****MI*234567890A~
TRN*2*ABCXYZ2~
STC*F0:3*20050915**7599*7599~
REF*1K*0529675341~
REF*BLT*111~
REF*EJ*JO234567~
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~
NM1*QC*1*MANN*JOSEPH~
TRN*2*ABCXYC3~
STC*F2:88:QC*20050612**150*0~
REF*1K*051681010827~
REF*EJ*MA345678~
SVC*HC:99203*150*0****1~
STC*F2:88:QC*20050612~
DTP*472*D8*20050501~
SE*38*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.

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