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X12 transaction guide · Healthcare and insurance

EDI 276 Health Care Claim Status Request

The X12 document providers or their agents use to ask a health care payer for the status of a claim or encounter already submitted.

Sent by
Healthcare provider or its authorized agent
Received by
Health care payer
Standard
ANSI ASC X12

What is an EDI 276?

The EDI 276 Health Care Claim Status Request is the ANSI X12 transaction set a provider, a recipient of health care products or services, or an authorized agent uses to request the status of a claim or encounter from a payer. It does not replace the 837 claim; it is sent after a claim has been submitted, and it can ask about the claim as a whole or about individual service lines.

The payer answers with a 277 claim status response. Under HIPAA, the 276/277 pair is the standard for electronic claim status inquiries in the United States.

How the EDI 276 worksDiagram of the EDI 276 Health Care Claim Status Request. Healthcare provider or its authorized agent sends it to health care payer. It usually follows 837. It is usually followed by 277 and 999. Inside the ISA, GS and ST envelopes, X12 release 008010 requires, in the heading: BHT (Beginning of Hierarchical Transaction) and detail: the required 2000 loop with HL (Hierarchical Level). 3 optional loops are listed by their first segment.How the EDI 276 worksHealth Care Claim Status Request: who sends it, where it fits and what the standard marks required1 WHERE IT FITSUSUALLY FOLLOWS837Health Care ClaimEDI 276SENDERHealthcare provider orits authorized agentRECEIVERHealth care payer997 or 999 acknowledgment back, if the partners agreeUSUALLY FOLLOWED BY277Health Care InformationStatus Notification999ImplementationAcknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDsISA … IEAFunctional group, ID code HRGS … GETransaction set 276ST … SEHEADINGBHTBeginning of Hierarchical Transaction+ 1 optional loop, starting with:NM1DETAILRequired loop 2000 · repeats many timesHLHierarchical Level+ 2 optional loops, starting with:NM1TRNBlue box: required loop. Optional loops are listed by the segment that starts them; when a loop is used, that first segment is required. Optional segmentsoutside loops are not drawn.Structure: required segments and loops in the X12 008010 listing for the 276. Your trading partner's implementation guide adds its own requirements.
How the EDI 276 worksDiagram of the EDI 276 Health Care Claim Status Request. Healthcare provider or its authorized agent sends it to health care payer. It usually follows 837. It is usually followed by 277 and 999. Inside the ISA, GS and ST envelopes, X12 release 008010 requires, in the heading: BHT (Beginning of Hierarchical Transaction) and detail: the required 2000 loop with HL (Hierarchical Level). 3 optional loops are listed by their first segment.How the EDI 276 worksHealth Care Claim Status Request: who sendsit, where it fits and what the standard marksrequired1 WHERE IT FITSUSUALLY FOLLOWS837Health Care ClaimEDI 276SENDERHealthcareprovider or itsauthorized agentRECEIVERHealth carepayer997 or 999 acknowledgment back, if the partnersagreeUSUALLY FOLLOWED BY277Health Care Information StatusNotification999Implementation Acknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDs (ISA… IEA)Functional group, ID code HR (GS … GE)Transaction set 276 (ST … SE)HEADINGBHTBeginning of HierarchicalTransaction+ 1 optional loop, starting with:NM1DETAILRequired loop 2000 · repeatsmany timesHLHierarchical Level+ 2 optional loops, starting with:NM1TRNBlue box: required loop. Optional loops are listedby the segment that starts them; when a loop isused, that first segment is required. Optionalsegments outside loops are not drawn.Structure: required segments and loops in the X12008010 listing for the 276. Your trading partner'simplementation guide adds its own requirements.

How to read this diagram: the top row shows who sends the 276, to whom, and which documents usually come before and after it. The lower part shows what X12 release 008010 itself requires: the envelopes around the 276 and the segments and loops the standard marks as required, area by area. Optional loops are listed by the segment that starts them rather than drawn in full. This is the standard's minimum, not a trading partner's requirement: each partner's implementation guide usually makes some optional loops mandatory, restricts the codes and may use a different release.

Expand diagram Download SVG

When it is used

  • Checking claims that have not been paid in the expected time
  • Following up on claims before resubmitting
  • Checking the status of individual service lines

Where it fits in the document flow

Usually follows 837 Health Care Claim
This document 276 Health Care Claim Status Request
Usually followed by 277 Health Care Information Status Notification999 Implementation Acknowledgment

Structure

Mandatory segments in the 276 (X12 release 008010)

The segments X12 release 008010 marks as mandatory at their level, in order. Segments inside optional loops are needed only when the loop is used. This is the standard's requirement, not your trading partner's: each partner's implementation guide names the release it uses, adds the optional segments it requires and restricts the values. The requirement status comes from one published X12 reference listing and has not been checked against a second source.

  • ST
  • BHT
  • NM1
  • HL
  • TRN
  • SVC
  • SE

Practical example

The 276 in practice

A physician group's billing system finds 40 claims older than 30 days without payment. It sends a 276 for each claim. The 277 replies show that most are in process, two were denied for missing information and one was never received, so the billing team corrects and resubmits only the claims that need it.

Implementation

Implementation considerations for the 276

  • Identify claims with the same identifiers used in the original 837.
  • Automate follow-up by claim age instead of checking status manually.
  • Follow payer companion guides on how often status may be requested.

How ECOM helps

Automate the 276 with ECOM

Industry

Healthcare

Secure B2B integration and file transfer for providers, suppliers, distributors and healthcare partners.

Solution

EDI Integration

Exchange X12 and EDIFACT documents with partners and integrate them directly with your ERP.

Service

Fully Managed EDI

ECOM operates your defined EDI services end to end under a service agreement.

More general questions about EDI are answered in the EDI FAQ.

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