276/277 claim status transaction

The 276/277 is the HIPAA standard for claim status, and Medicare’s EDI manual lists its version as 005010X212¹. Its CAQH CORE operating rules have applied since January 1, 2013². The 277 answers with codes from two X12 lists, and under HIPAA every payer has to use them in its 276/277 claim status responses^3,5. A claim status category code sorts the answer into a group: an acknowledgment, a pending claim, a finalized claim, a request for more information, or an error that kept the payer from answering. A claim status code then gives the detail³. Medicare takes 276 requests electronically and sends back the 277, which CMS says is designed so status can post to patient accounts automatically⁴.

Claim status is how A/R follow-up works without a phone queue. A batch of 276s on every claim past a set age shows which claims the payer is holding, which are still pending and which it has finalized. It also finds the claims the payer never received. Medicare’s EDI manual says a status response with no record of a claim suggests a front-end rejection, and the claim can then be sent again¹.

Do not confuse the 277 response with the 277CA. Both use the X12 277, but the 277CA comes back on its own after the payer receives an 837, while the 277 here answers only a question you asked. The other mistake is reading status responses one at a time. The codes are built for systems: route them into work queues by category, so a request for records reaches someone the same day it arrives.