EDI 276 277: Claim Status Inquiry and Response 2025

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The 276 transaction is used to request claim status and the 277 transaction is used to respond with this information for the specified claim. The Council for Affordable and Quality Healthcare (CAQH) created the Committee on Operating Rules for Information Exchange (CORE).
Denial code 276 is used when the current payer denies coverage for a service that was previously denied by another payer. In other words, it means that the current insurance provider will not cover the cost of the service because it was already determined to be not covered by a previous insurance provider.
A 277 transaction may be sent in response to a previously received EDI 276 Claim Status Inquiry. A payer may use a 277 to request additional information about a submitted claim (without a 276) A payer may provide claim status information to a provider using the 277, without receiving a 276.
You can submit claim status inquiries through your EDI vendor or practice management system. Inquiries submitted with a NPI will return claims submitted with the same NPI. 276 Inquiries, cont. You receive a response in seconds!
Some providers can enter claim status queries via direct data entry screens. Providers can send a Health Care Claim Status Request (276 transaction) electronically and receive a Health Care Claim Status Response (277 transaction) back from Medicare.

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Submitting a 276 status request to a payer is the first step in the claim status request/response process. The payer provides the requested information in response to the 276 request using a 277 Claim Status Response transaction.
Denial code 276 is used when the current payer denies coverage for a service that was previously denied by another payer.

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