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X12 transaction guide · Healthcare and insurance

EDI 277 Health Care Information Status Notification

The X12 document health care payers use to report the status of a claim or encounter, or to request additional information from the provider.

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

What is an EDI 277?

The EDI 277 Health Care Information Status Notification is the ANSI X12 transaction set a payer or its agent uses to notify a provider about the status of a health care claim or encounter, or to request additional information about a claim, a services review or related transactions. It does not replace the payment advice, which is the 835.

The 277 most often answers a 276 claim status request, but payers also use it on their own initiative, for example to acknowledge claims received or to ask for documentation needed to process a claim.

How the EDI 277 worksDiagram of the EDI 277 Health Care Information Status Notification. Health care payer or its authorized agent sends it to healthcare provider or its authorized agent. It usually follows 276 and 837. It is usually followed by 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 277 worksHealth Care Information Status Notification: who sends it, where it fits and what the standard marks required1 WHERE IT FITSUSUALLY FOLLOWS276Health Care Claim StatusRequest837Health Care ClaimEDI 277SENDERHealth care payer orits authorized agentRECEIVERHealthcare provider orits authorized agent997 or 999 acknowledgment back, if the partners agreeUSUALLY FOLLOWED BY999ImplementationAcknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDsISA … IEAFunctional group, ID code HNGS … GETransaction set 277ST … 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 277. Your trading partner's implementation guide adds its own requirements.
How the EDI 277 worksDiagram of the EDI 277 Health Care Information Status Notification. Health care payer or its authorized agent sends it to healthcare provider or its authorized agent. It usually follows 276 and 837. It is usually followed by 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 277 worksHealth Care Information Status Notification:who sends it, where it fits and what thestandard marks required1 WHERE IT FITSUSUALLY FOLLOWS276Health Care Claim Status Request837Health Care ClaimEDI 277SENDERHealth carepayer or itsauthorized agentRECEIVERHealthcareprovider or itsauthorized agent997 or 999 acknowledgment back, if the partnersagreeUSUALLY FOLLOWED BY999Implementation Acknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDs (ISA… IEA)Functional group, ID code HN (GS … GE)Transaction set 277 (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 277. Your trading partner'simplementation guide adds its own requirements.

How to read this diagram: the top row shows who sends the 277, 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 277 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

  • Answering a provider's 276 claim status request
  • Reporting claims accepted or rejected at intake
  • Requesting additional documentation for a claim

Where it fits in the document flow

Usually follows 276 Health Care Claim Status Request837 Health Care Claim
This document 277 Health Care Information Status Notification
Usually followed by 999 Implementation Acknowledgment

Structure

Mandatory segments in the 277 (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
  • PWK
  • SVC
  • SE

Practical example

The 277 in practice

A payer receives a batch of 837 claims from a hospital. It sends a 277 reporting which claims were accepted into processing and which were rejected for invalid member identifiers. The hospital's billing system routes the rejections to staff, who correct the identifiers and resubmit the same day.

Implementation

Implementation considerations for the 277

  • Route status codes that need action, such as requests for information, to work queues.
  • Match each 277 to the claims it reports on using the claim identifiers.
  • Track rejection reasons to fix recurring problems at the source.

How ECOM helps

Automate the 277 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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