EDI 277 Health Care Information Status Notification

This X12 Transaction Set contains the format and establishes the data contents of the Health Care Information 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, health care services review, or transactions related to the provisions of health care. 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.

Segments

Position

Segment

Name

Max use

100

Transaction Set Header

Mandatory

AtMax 1

To indicate the start of a transaction set and to assign a control number

200

BHT

Beginning of Hierarchical Transaction

Mandatory

AtMax 1

To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time

300

REF

Reference Information

Opt

AtMax 10

To specify identifying information

1000

LOOP

Opt

GT 1

400

NM1

Individual or Organizational Name

Opt

AtMax 1

To supply the full name of an individual or organizational entity

500

Additional Name Information

Opt

AtMax 2

To specify additional names

600

Party Location

Opt

AtMax 2

To specify the location of the named party

700

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

800

REF

Reference Information

Opt

AtMax 2

To specify identifying information

900

PER

Administrative Communications Contact

Opt

AtMax 3

To identify a person or office to whom administrative communications should be directed

2000

LOOP

Mandatory

GT 1

100

Hierarchical Level

Mandatory

AtMax 1

To identify dependencies among and the content of hierarchically related groups of data segments

200

SBR

Subscriber Information

Opt

AtMax 1

To record information specific to the primary insured and the insurance carrier for that insured

300

PAT

Patient Information

Opt

AtMax 1

To supply patient information

400

DMG

Demographic Information

Opt

AtMax 1

To supply demographic information

2100

LOOP

Opt

GT 1

500

NM1

Individual or Organizational Name

Opt

AtMax 1

To supply the full name of an individual or organizational entity

600

Party Location

Opt

AtMax 2

To specify the location of the named party

700

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

800

PER

Administrative Communications Contact

Opt

AtMax 3

To identify a person or office to whom administrative communications should be directed

850

REF

Reference Information

Opt

AtMax 9

To specify identifying information

2200

LOOP

Opt

GT 1

900

TRN

Trace

Opt

AtMax 1

To uniquely identify a transaction to an application

1000

STC

Status Information

Opt

GT 1

To report the status, required action, and paid information of a claim or service line

1100

REF

Reference Information

Opt

AtMax 9

To specify identifying information

1200

DTP

Date or Time or Period

Opt

AtMax 5

To specify any or all of a date, a time, or a time period

1210

QTY

Quantity Information

Opt

AtMax 5

To specify quantity information

1220

AMT

Monetary Amount Information

Opt

AtMax 5

To indicate the total monetary amount

2210

LOOP

Opt

GT 1

1300

PWK

Paperwork

Opt

AtMax 1

To identify the type or transmission or both of paperwork or supporting information

1400

PER

Administrative Communications Contact

Opt

AtMax 3

To identify a person or office to whom administrative communications should be directed

1500

Party Identification

Opt

AtMax 1

To identify a party by type of organization, name, and code

1600

Party Location

Opt

AtMax 1

To specify the location of the named party

1700

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

2220

LOOP

Opt

GT 1

1800

SVC

Service Information

Opt

AtMax 1

To supply payment and control information to a provider for a particular service

1900

STC

Status Information

Opt

GT 1

To report the status, required action, and paid information of a claim or service line

2000

REF

Reference Information

Opt

AtMax 9

To specify identifying information

2100

DTP

Date or Time or Period

Opt

AtMax 1

To specify any or all of a date, a time, or a time period

2150

TOO

Tooth Identification

Opt

GT 1

To identify a tooth by number and, if applicable, one or more tooth surfaces

2225

LOOP

Opt

GT 1

2200

PWK

Paperwork

Opt

AtMax 1

To identify the type or transmission or both of paperwork or supporting information

2300

PER

Administrative Communications Contact

Opt

AtMax 3

To identify a person or office to whom administrative communications should be directed

2400

Party Identification

Opt

AtMax 1

To identify a party by type of organization, name, and code

2500

Party Location

Opt

AtMax 1

To specify the location of the named party

2600

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

2700

Transaction Set Trailer

Mandatory

AtMax 1

To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

Elements

Position	Element	Name	Requirement	Type	Min/Max	Repeat

1	143	Transaction Set Identifier Code	Mandatory	ID	3/3	1

2	329	Transaction Set Control Number	Mandatory	Alphanumeric	4/9	1

3	1705	Implementation Convention Reference	Opt	Alphanumeric	1/35	1

EDI Dictionary

EDI 277 Health Care Information Status Notification

Segments

Elements