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Updated:05/16/2008

HIPAA 276 Health Care Claim Status Request
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.

276
Health Care Claim Status Request
Functional Group=HR

This Draft Standard for Trial Use contains the format and establishes the data contents of the Health Care Claim Status Request Transaction Set (276) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used by a provider, recipient of health care products or services, or their authorized agent to request the status of a health care claim or encounter from a health care payer. This transaction set is not intended to replace the Health Care Claim Transaction Set (837), but rather to occur after the receipt of a claim or encounter information. The request may occur at the summary or service line detail level.

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 REF Payer Claim Identification Number O 1
100 REF Institutional Bill Type Identification O 1
100 REF Medical Record Identification O 1
110 AMT Claim Submitted Charges O 1
120 DTP Claim Service Date O 1
Loop ID - 2210D >1
130 SVC Service Line Information O 1
140 REF Service Line Item Identification O 1
150 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 REF Payer Claim Identification Number O 1
100 REF Institutional Bill Type Identification O 1
100 REF Medical Record Identification O 1
110 AMT Claim Submitted Charges O 1
120 DTP Claim Service Date O 1
Loop ID - 2210E >1
130 SVC Service Line Information O 1
140 REF Service Line Item Identification O 1
150 DTP Service Line Date O 1
160 SE Transaction Set Trailer M 1

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