By | 2019-09-13T05:48:20+00:00 September 13th, 2019|

What is an EDI 276-A1 Health Care Claim Status Request?

The EDI 276-A1 Health Care Claim Status Request transaction set is used by healthcare providers to verify the status of a claim, previously submitted by a payer, such as an insurance company. This transaction set is used to convey information, including patient and provider identification details, date of service, subscriber information, and charges.

EDI X12 276-A1 Health Care Claim Status Request Sample

An EDI 276-A1 document is divided into functional groups that explain the contents of the transaction being conducted. A typical EDI 276-A1 document looks like this[1]:

ST*276*0046!
BHT*0010*13**20030109!
HL*1**20*1! NM1*PR*2* PAYER NAME ****21*9012345918341!
PER*IC*PROVIDER CONTACT INFO*TE*6145551212! HL*2*1*21*1! NM1*41*2******46*111222333! HL*3*2*19*1!
NM1*1P*2*PROVIDER NAME*****FI*FEDERAL TAX ID!
NM1*1P*2*PROVIDER NAME*****XX*NPI NUMBER!
NM1*1P*2*PROVIDER NAME*****SV*PROVIDER NUMBER!
HL*4*3*22*1! NM1*IL*1*DOE*JOHN****MI*MEMBERID TRN*1*500!
HL*5*4*23! DMG*D8*19171106*F!
NM1*QC*1*DOE*JANE!
TRN*1*500!
AMT*T3*68.69!
DTP*232*RD8*20021016-20021016!
SE*19*0046!

Workflow for the Exchange of an EDI 276-A1 Health Care Claim Status Request

Information requested in an EDI 276-A1 transaction set is transmitted using the EDI 277-A1 Health Care Claim Status Notification document. The EDI 276-A1 and 277-A1 transaction sets are often used together in the healthcare data exchange, and help healthcare service providers stay in compliance with HIPAA standards.

Achieve EDI Compliance with Astera EDIConnect

Astera EDIConnect is an enterprise-grade EDI solution that simplifies the process of sending and receiving EDI messages. With a built-in EDI parser, validator, and transaction builder, Astera EDIConnect can handle transaction sets in X12, EDIFACT, and HL7 formats. It also offers code-free mapping of data to EDI formats and workflow automation to streamline the EDI process.

[1] https://www.amerihealth.com/pdfs/providers/claims_and_billing/edi/276_277.pdf

Find out more about the industries we’ve helped and how we did it.