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Updated:09/19/2008

HIPAA 277 Health Care Claim Status Notification
Management Systems Consulting, Inc.
VERSION: 1.0 DRAFT

Author: Skip Stein

Notes: In order to protect the security and confidentiality of electronic health information, Congress has passed The Health Insurance Portability and Accountability Act, also known as HIPAA, which was the result of efforts by the Clinton Administration and congressional healthcare reform proponents to reform healthcare in a way that would streamline industry inefficiencies, reduce paperwork, make it easier to detect and prosecute fraud and abuse and enable workers of all professions to change jobs, even if they (or family members) had pre-existing medical conditions.

277
Health Care Claim Status Notification
Functional Group=HN

This Draft Standard for Trial Use contains the format and establishes the data contents of the Health Care Claim Status Notification Transaction Set (277) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used by a health care payer or authorized agent to notify a provider, recipient, or authorized agent 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. This transaction set is not intended to replace the Health Care Claim Payment/Advice Transaction Set (835) and therefore, will not be used for account payment posting. The notification may be at a summary or service line detail level. The notification may be solicited or unsolicited.

Heading:
Pos Id Segment Name Req Max Use Repeat Notes Usage
010 ST Transaction Set Header M 1
020 BHT Beginning of Hierarchical Transaction M 1
Detail:
Pos Id Segment Name Req Max Use Repeat Notes Usage
Loop ID - 2000A >1
010 HL Information Source Level M 1
Loop ID - 2100A >1
050 NM1 Payer Name O 1
080 PER Payer Contact Information O 1
Loop ID - 2000B >1
010 HL Information Receiver Level M 1
Loop ID - 2100B >1
050 NM1 Information Receiver Name O 1
Loop ID - 2000C >1
010 HL Service Provider Level M 1
Loop ID - 2100C >1
050 NM1 Provider Name O 1
Loop ID - 2000D >1
010 HL Subscriber Level M 1
040 DMG Subscriber Demographic Information O 1 N2/040
Loop ID - 2100D >1
050 NM1 Subscriber Name O 1
Loop ID - 2200D >1
090 TRN Claim Submitter Trace Number O 1
100 STC Claim Level Status Information M 1
110 REF Payer Claim Identification Number O 1
110 REF Institutional Bill Type Identification O 1
110 REF Medical Record Identification O 1
120 DTP Claim Service Date O 1
Loop ID - 2220D >1
180 SVC Service Line Information O 1
190 STC Service Line Status Information M 1
200 REF Service Line Item Identification O 1
210 DTP Service Line Date O 1
Loop ID - 2000E >1
010 HL Dependent Level O 1
040 DMG Dependent Demographic Information O 1 N2/040
Loop ID - 2100E >1
050 NM1 Dependent Name O 1
Loop ID - 2200E >1
090 TRN Claim Submitter Trace Number O 1
100 STC Claim Level Status Information M 1
110 REF Payer Claim Identification Number O 1
110 REF Institutional Bill Type Identification O 1
110 REF Medical Record Identification O 1
120 DTP Claim Service Date O 1
Loop ID - 2220E >1
180 SVC Service Line Information O 1
190 STC Service Line Status Information M 1
200 REF Service Line Item Identification O 1
210 DTP Service Line Date O 1
270 SE Transaction Set Trailer M 1

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