EDI 277

Healthcare Claim Status Notification

The EDI 277 transaction, also known as a Healthcare Claim Status Notification, is an electronic response sent by an insurance company or payor in reply to an EDI 276 Claim Status Request. It provides healthcare providers with updates on the status of a previously submitted claim.

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What is an EDI 277?

The EDI 277 transaction, also known as a Healthcare Claim Status Notification, is an EDI transaction used in the healthcare industry to provide updates on the status of a submitted claim. It is sent by an insurance company or payor in response to an EDI 276 Healthcare Claim Status Request, which is submitted by healthcare providers seeking information on the processing of a specific claim.

The EDI 277 transaction helps providers track claims efficiently, reduce manual follow-ups, and address any issues that may delay reimbursement.

How to use an EDI 277?

A provider submits a claim to the insurance company (typically via an EDI 837 transaction).
If the provider needs to check the claim’s status, they send an EDI 276 Claim Status Request to the payor.
The payor processes the request and sends back an EDI 277 Claim Status Notification, updating the provider on the status of the claim.
Based on the response, the provider can take necessary actions, such as resubmitting a corrected claim or following up on pending payments.

By automating claim status tracking, the EDI 277 transaction reduces administrative burdens, minimizes errors, and helps healthcare providers get faster insights into their claims, ultimately improving cash flow and operational efficiency.

What Information Does the EDI 277 Include?

The key components of an EDI 277 transaction are:

Claim Status Information – The core purpose of the EDI 277 is to inform the provider whether a claim has been accepted, processed, denied, paid, or requires additional information.
Claim Tracking Number – A unique reference number assigned to the claim, allowing providers to track its progress.
Patient Information – Includes details such as the patient’s name, date of birth, and member ID to ensure accurate claim identification.
Provider Details – Information about the healthcare provider, such as name, National Provider Identifier (NPI), and Tax Identification Number (TIN).
Payer/Insurance Details – The name and identification number of the insurance company or payor processing the claim.
Status Codes & Explanation – The EDI 277 includes standardized claim status category codes (CSCC) and claim status codes (CSC) that explain why a claim was approved, denied, or is still pending. If a claim is denied, the response may provide instructions on how to correct and resubmit it.

HIPAA Compliance and EDI 277

As of March 31, 2012, healthcare providers must comply with HIPAA version 5010 for EDI transactions. EDI/HQ™ Healthcare software ensures full HIPAA-compliant EDI processing, offering:

Advanced EDI translation
Superior mapping and integration
Enhanced data management

Other Common X12 Transactions Related to EDI 277

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Cleo can assist with EDI 277s (and so much more)

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