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.
To indicate the start of a transaction set and to assign a control number
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
To specify identifying information
To supply the full name of an individual or organizational entity
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To specify identifying information
To identify a person or office to whom administrative communications should be directed
To identify dependencies among and the content of hierarchically related groups of data segments
To record information specific to the primary insured and the insurance carrier for that insured
To supply patient information
To supply demographic information
To supply the full name of an individual or organizational entity
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To uniquely identify a transaction to an application
To report the status, required action, and paid information of a claim or service line
To specify identifying information
To specify any or all of a date, a time, or a time period
To identify the type and transmission of paperwork or supporting information
To identify a person or office to whom administrative communications should be directed
To identify a party by type of organization, name, and code
To specify the location of the named party
To specify the geographic place of the named party
To supply payment and control information to a provider for a particular service
To report the status, required action, and paid information of a claim or service line
To specify identifying information
To specify any or all of a date, a time, or a time period
To identify the type and transmission of paperwork or supporting information
To identify a person or office to whom administrative communications should be directed
To identify a party by type of organization, name, and code
To specify the location of the named party
To specify the geographic place of the named party
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
