If submitters have made a request of PHC for a claim that should be handled by one of our vendors, submitters will receive a 277 Response indicating that the data could not be found. See the Claim Status Category Code Table, code source 507 or 508, for more information about response codes used in the 277 Transaction. CLAIM STATUS CATEGORY AND STATUS CODE Response uses the Claim Status Category Codes and Status Codes to identify security validation requirement issues and to indicate PHC business edits. The following table lists all codes supported by PHC within the 277 Transaction, Loop 2200D, Elements STC01-1 and STC01-2. The first column lists the codes used for the STC01-1 element and the corresponding STC01-2 value appears in the second column. Claim Claim Status Status Category Claim Status Category Code Descriptions Claim Status Code Descriptions Code Code STC01 STC02 F1 65 Finalized/Payment-The claim/line has been paid. Claim/line has been paid. Finalized/Revised - Adjudication information F3 519 has been changed Adjustment Amount Pending/In Process-The claim or encounter is in P1 20 the adjudication system. Accepted for processing. Pending/Payer Review-The claim/encounter is Line Adjudication Information. suspended and is pending review (e.g. medical Note: At least one other status P2 710 review, re-pricing, Third Party Administrator code is required to identify the processing). data element in error. Denied Charge or Non-covered F2 585 Finalized/Denial-The claim/line has been denied. Charge Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been F4 696 adjudicated and no further payment is forthcoming. Claim Adjustment Group Code. Claim assigned to an P5 55 Pending/Payer Administrative/System hold approver/analyst. ACKNOWLEDGEMENTS AND/OR REPORTS For each 276 Claim Status Request submitted to PHC, one of the following will be returned: TA1 Interchange Acknowledgement if the ISA/IEA envelope cannot be processed. 999 Implementation Acknowledgement if the 276 transaction contains HIPAA compliancy errors within the ST/SE segments. 277 Claim Status Response containing the requested claim inquiry. TRADING PARTNER AGREEMENTS A completed EDI Enrollment form is required for all providers, clearinghouses and software vendors wishing to connect directly with PHC to exchange Claim Status Request and Response (276/277) transactions.
If submitters have made a request of PHC for a claim that should be handled by one of our vendors, submitters will receive a 277 Response indicating that the data could not be found. See the Claim Status Category Code Table, code source 507 or 508, for more information about response codes used in the 277 Transaction. CLAIM STATUS CATEGORY AND STATUS CODE Response uses the Claim Status Category Codes and Status Codes to identify security validation requirement issues and to indicate PHC business edits. The following table lists all codes supported by PHC within the 277 Transaction, Loop 2200D, Elements STC01-1 and STC01-2. The first column lists the codes used for the STC01-1 element and the corresponding STC01-2 value appears in the second column. Claim Status Category Code STC01 Claim Status Code STC02 Claim Status Category Code Descriptions Claim Status Code Descriptions F1 65 Finalized/Payment-The claim/line has been paid. Claim/line has been paid. F3 519 Finalized/Revised - Adjudication information has been changed Adjustment Amount P1 20 Pending/In Process-The claim or encounter is in the adjudication system. Accepted for processing. P2 710 Pending/Payer Review-The claim/encounter is suspended and is pending review (e.g. medical review, re-pricing, Third Party Administrator processing). Line Adjudication Information. Note: At least one other status code is required to identify the data element in error. F2 585 Finalized/Denial-The claim/line has been denied. Denied Charge or Non-covered Charge F4 696 Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming. Claim Adjustment Group Code. P5 55 Pending/Payer Administrative/System hold Claim assigned to an approver/analyst. ACKNOWLEDGEMENTS AND/OR REPORTS For each 276 Claim Status Request submitted to PHC, one of the following will be returned: TA1 Interchange Acknowledgement if the ISA/IEA envelope cannot be processed. 999 Implementation Acknowledgement if the 276 transaction contains HIPAA compliancy errors within the ST/SE segments. 277 Claim Status Response containing the requested claim inquiry. TRADING PARTNER AGREEMENTS A completed EDI Enrollment form is required for all providers, clearinghouses and software vendors wishing to connect directly with PHC to exchange Claim Status Request and Response (276/277) transactions.
PHC_EDI_CORE_276_277_CG.docx