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HIPAA Simplified
Claim Status
The ASC X12N Health Care Claim Status Request and Response (276/277) is a paired transaction set consisting of a Request (276) and a Response (277).
The Request is used by the submitter of the claim to determine the status of a claim or claims previously submitted. The Response is returned by the payer and the information provided indicates where the claim is in the adjudication process (for example, pending, finalized) and if finalized, the disposition of the claim (for example, paid, denied). For denied or rejected, the reason for the denial or rejection is included.
Depending on how the payer or other entity adjudicates claims, the Response can report the status of individual services submitted in the claim.
Standards
Current Version
The current industry version of the ASC X12N Health Care Claim Status Request and Response (276/277) is 5010. This version was adopted under HIPAA to replace version 4010 on January 16, 2009.
The Technical Report Type 3 ASC X12N/005010X212 Health Care Claim Status Request and Response (276/277) can be purchased at the www.x12.org/products.
Next Published Version
The next published version of the ASC X12N Health Care Claim Status Request and Response (276/277) will be version 7030TM.
See the Change Healthcare Regulatory and Standards Quarterly Update for details concerning the X12 publication schedule.
Anticipated Regulation
Immediately following publication of 7030TM, X12 will promote the TR3 to version 8010 TM and is expected to recommend the 8010 TM version to CMS for adoption under HIPAA.
Note: Following the publication of version 8010, X12 will move to an annual release cycle of TR3s. See https://x12.org/about/arc-faq for more information.
7030TM and 8010TM are trademarks of X12. All rights reserved.