X12 HIPAA 276 Request Transmission
The EDI 276 transaction set is a Health Care Claim Status Inquiry. It is used by healthcare providers to verify the status of a claim submitted previously to a payer, such as an insurance company, HMO, government agency like Medicare or Medicaid, etc. The 276 transaction is specified by HIPAA for the electronic submission of claim status requests. The transaction typically includes:
- Provider identification
- Patient identification
- Subscriber information
- Date(s) of service(s)
- Charges
Submitting a 276 status request to a payer is the first step in the claim status request/response process. The payer provides the requested information in response to the 276 request using a 277 Claim Status Response transaction. Inbound 276 transactions may also result in an immediate 999 Receipt Acknowledgement, followed by the 277 response with the requested status information. The use of EDI 276 inquiries, along with the 277 response, replaces the manual process of managing payments and claims.
Hospital or clinic administrators process hundreds of claims or more. Waiting for payments or monthly statements from insurance companies before the provider can reconcile their charges and billing patients for their portion means the entire process could take months for each transaction. By submitting the inquiry via EDI with the 276 transaction, administrators can receive the information more quickly and with little or no manual intervention.
X12 HIPAA 276 Specification
X12 HIPAA 276 specification is available at:
X12 HIPAA 276 Code Example
X12 HIPAA 276 code example is available at:
X12 HIPAA 276 Sample File
ISA*00* *00* *ZZ*1234567 *ZZ*11111 *170508*1141*^*00501*000000101*1*P*:~ GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X212~ 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~ GE*1*101~ IEA*1*000000101~
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