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276Health Care Claim Status Request

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.

  • ST
    Transaction Set Header
    M必须(Mandatory)
    Repeat 1

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

  • BHT
    Beginning of Hierarchical Transaction
    M必须(Mandatory)
    Repeat 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

  • REF
    Reference Numbers
    O可选(Optional)
    Repeat 10

    To specify identifying numbers.

  • NM1Loop1Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
    NM1N2N3N4REFPER
    • NM1
      Individual or Organizational Name
      M必须(Mandatory)
      Repeat 1

      To supply the full name of an individual or organizational entity

    • N2
      Additional Name Information
      O可选(Optional)
      Repeat 2

      To specify additional names or those longer than 35 characters in length

    • N3
      Address Information
      O可选(Optional)
      Repeat 2

      To specify the location of the named party

    • N4
      Geographic Location
      O可选(Optional)
      Repeat 1

      To specify the geographic place of the named party

    • REF
      Reference Numbers
      O可选(Optional)
      Repeat 2

      To specify identifying numbers.

    • PER
      Administrative Communications Contact
      O可选(Optional)
      Repeat 1

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

  • HLLoop1Hierarchical Level LOOPM必须(Mandatory)Repeat > 1
    HLSBRPATDMGNM1Loop2TRNLoop1
    • HL
      Hierarchical Level
      M必须(Mandatory)
      Repeat 1

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

    • SBR
      Subscriber Information
      O可选(Optional)
      Repeat 1

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

    • PAT
      Patient Information
      O可选(Optional)
      Repeat 1

      To supply patient information

    • DMG
      Demographic Information
      O可选(Optional)
      Repeat 1

      To supply demographic information

    • NM1Loop2Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
      NM1N3N4PER
      • NM1
        Individual or Organizational Name
        M必须(Mandatory)
        Repeat 1

        To supply the full name of an individual or organizational entity

      • N3
        Address Information
        O可选(Optional)
        Repeat 2

        To specify the location of the named party

      • N4
        Geographic Location
        O可选(Optional)
        Repeat 1

        To specify the geographic place of the named party

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat 1

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

    • TRNLoop1Trace LOOPO可选(Optional)Repeat > 1
      TRNREFAMTDTPSVCLoop1
      • TRN
        Trace
        M必须(Mandatory)
        Repeat 1

        To uniquely identify a transaction to an application.

      • REF
        Reference Numbers
        O可选(Optional)
        Repeat 3

        To specify identifying numbers.

      • AMT
        Monetary Amount
        O可选(Optional)
        Repeat 1

        To indicate the total monetary amount.

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 2

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

      • SVCLoop1Service Information LOOPO可选(Optional)Repeat > 1
        SVCREFDTP
        • SVC
          Service Information
          M必须(Mandatory)
          Repeat 1

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

        • REF
          Reference Numbers
          O可选(Optional)
          Repeat 1

          To specify identifying numbers.

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 1

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

  • SE
    Transaction Set Trailer
    M必须(Mandatory)
    Repeat 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).

Segment
X12 EDI Release 00304
STTransaction Set Header
To indicate the start of a transaction set and to assign a control number
Elements
  • ST01143Transaction Set Identifier Code
    ID
    M必须(Mandatory)
    Min 3 / Max 3

    Code uniquely identifying a Transaction Set.

    Codes (320)
  • ST02329Transaction Set Control Number
    AN
    M必须(Mandatory)
    Min 4 / Max 9

    Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

  • ST031705Implementation Convention Preference
    AN
    O可选(Optional)
    Min 1 / Max 9

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