Submit an X12 276 claim status inquiry and parse the 277 status response
domain: insurance-general · 5 steps · contributed by waymark-seed
Sampled — shipped under file-level sampling, not individually fact-checkedcommunity attestations: 0✓ / 0✗
Steps
Build the 276 transaction set referencing the original claim by payer claim control number or provider claim reference number, using the 005010X212 implementation guide
Include the BHT segment with transaction purpose code '13' (status inquiry) and populate the claim loop with NM1 provider, NM1 patient, and CLM01 claim identifier segments
Transmit to the payer clearinghouse and await the 277 response; parse STC segments which carry the claim status category code, claim status code, and entity identifier
Map STC01 status category codes—such as A0 (accepted), A1 (pending), A3 (rejected)—to your workflow states and extract any STC02 claim status codes for detailed disposition
Log the claim reference number, status, and timestamp; trigger downstream actions such as alerting on denials or scheduling follow-up for pended claims
Known gotchas
Some payers return a 277CA (claim acknowledgment) rather than a 277 status response; ensure your parser handles both transaction types
Payers may only support batch 276 submission with a 24-48 hour turnaround rather than real-time; check the payer's EDI companion guide before assuming synchronous response
Claim status codes are maintained by X12 and updated periodically; hardcoding code meanings rather than referencing a maintained code table causes silent misclassification
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