JSON Schema for 277CA X214 (Claim Status)

Overview

Root objects:

Resources:

Claim Status

Status of a single claim. Also contains patient, provider and receiver information.
Loop: 2200D JSON Example Interactive Example Open API Schema
NameDescriptionTypeEDI Reference

id

Unique payment identifier assigned by the converter

String

objectType

Type of this object, always set to 'CLAIM_STATUS'

String

patient

The insured (subscriber) or patient as stated on 837 claim

PartyIdName

2100D

NM1*QC

patientControlNumber

Patient control number

String

TRN02

statusInfos

Status infos

List of StatusInfo

payerClaimControlNumber

Payer claim control number

String

REF02*1K

clearinghouseTraceNumber

Clearinghouse trace number

String

REF02*D9

billTypeCode

Bill type code

String

REF02*BLT

serviceDateFrom

Service date for professional or statement date for institutional

Date

DTP03*472

serviceDateTo

The end date of the service or statement date period. Set to 'serviceDateFrom' if the period is a single date

Date

DTP03*472

receiver

The Receiver is the entity that expects the response from the Source. Can be a provider, a provider group, a claims clearinghouse, etc.

PartyIdName

2000B

NM1*40

receiverBatchStatus

Receiver batch status

BatchStatus

2200B

provider

Billing provider for 277CA

PartyIdName

2100C

NM1*85

providerBatchStatus

Provider batch status

BatchStatus

2200C

lineStatuses

Rejected service lines

List of ServiceLineStatus

2220D

transaction

Parent EDI transaction for this object

Transaction277

ST

Receiver-Level Status

Status of claims at a transaction level. This object is returned only if all claims have been rejected and no individual claim statuses have been provided.
Open API Schema
NameDescriptionTypeEDI Reference

id

Unique payment identifier assigned by the converter

String

objectType

Type of this object, set to 'PROVIDER_STATUS' or 'RECEIVER_STATUS'

String

batchStatus

Batch status

BatchStatus

transaction

Parent EDI transaction for this object

Transaction277

ST

receiver

The Receiver is the entity that expects the response from the Source. Can be a provider, a provider group, a claims clearinghouse, etc.

PartyIdName

2000B

NM1*40

Provider-Level Status

Status of claims at a provider level. This object is returned only if there is an issue with the billing provider and no individual claim statuses have been provided.
Open API Schema
NameDescriptionTypeEDI Reference

id

Unique payment identifier assigned by the converter

String

objectType

Type of this object, set to 'PROVIDER_STATUS' or 'RECEIVER_STATUS'

String

batchStatus

Batch status

BatchStatus

transaction

Parent EDI transaction for this object

Transaction277

ST

receiver

The Receiver is the entity that expects the response from the Source. Can be a provider, a provider group, a claims clearinghouse, etc.

PartyIdName

2000B

NM1*40

receiverBatchStatus

Receiver batch status

BatchStatus

2200B

Service Line Status

Service line information and its status
Loop: 2220D Open API Schema
NameDescriptionTypeEDI Reference

controlNumber

Line item control number from 837

String

REF02*6R

chargeAmount

Charge amount

Number

SVC02

unitCount

Unit count

Number

SVC07

procedure

Procedure

View codes and descriptions

Procedure

SVC01

revenueCode

Revenue code

View codes and descriptions

Code

SVC01
SVC04

prescriptionNumber

Prescription number

String

REF02*XZ

serviceDateFrom

Service period start date

Date

DTP03*472
DTP03*150

serviceDateTo

Service period end date. If not provided in EDI (single day), it is set to 'serviceDateFrom'

Date

DTP03*151

statusInfos

Status infos

List of StatusInfo

Status Info

Status Information
Segment: STC Open API Schema
NameDescriptionTypeEDI Reference

effectiveDate

Effective date

Date

STC02

actionCode

Action code

String

STC03

actionType

Status action type (action code translated to constant/enum), ACCEPT or REJECT

String

STC03

chargeAmount

Charge amount

Number

STC04

statusCodeInfos

Status code infos

List of StatusCodeInfo

STC01
STC10
STC11

message

Message

String

STC12

Status Code Info

Contains sub-elements of the composite healthcare claim status element (STC01,STC10,STC11)
Open API Schema
NameDescriptionTypeEDI Reference

categoryCode

Category code

String

STC01-1

statusCode

Status code

String

STC01-2

entityCode

Entity code

String

STC01-3

Batch Status

Status of multiple claims provided at a provider or a receiver level. At the receiver level, this is a status of all claims in the transaction.
Open API Schema
NameDescriptionTypeEDI Reference

traceIdentifier

Transaction control number from 837 for the status at the receiver level. It is a dummy number for the provider-level status; should be ignored.

String

TRN02

statusInfos

Status infos

List of StatusInfo

acceptedQuantity

Accepted quantity

Number

QTY02*QA

acceptedAmount

Accepted amount

Number

AMT02*YU

rejectedQuantity

Rejected quantity

Number

QTY02*QC

rejectedAmount

Rejected amount

Number

AMT02*YY

Organization Or Person ID and Name

Open API Schema
NameDescriptionTypeEDI Reference

entityRole

Entity role

View codes and descriptions

String

Required

NM101
N101

entityType

Type of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for person

Values:

BUSINESS(2), INDIVIDUAL(1)

String (enum)

Required

NM102

identificationType

Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)

View codes and descriptions

String

NM108
N103

identifier

Identifier

String

NM109
N104

taxId

Tax id

String

REF02*TJ
REF02*SY
REF02*EI

lastNameOrOrgName

Organization name or person last name

String

NM103
N102

firstName

First name

String

NM104

middleName

Middle name

String

NM105

Procedure

Procedure code with description and optional modifiers
Segment: HI,SV1,SV2,SV3,SVC Open API Schema
Extends: Code
NameDescriptionTypeEDI Reference

modifiers

Modifiers

List of Code

837P:SV101-3-6
837I:SV201-3-6
835:SVC01-3-6
277:SVC01-3-6

Code

Code and description
Open API Schema
NameDescriptionType

subType

Healthcare code subtype, such as CPT, HCPCS, ICD_10, NDC

String

code

Healthcare code

String

Required

desc

Code description

String

EDI Transaction Info

Open API Schema
NameDescriptionTypeEDI Reference

controlNumber

Control number

String

ST02

transactionType

Transaction type translated to string constant, PROF for 837P, INST for 837I, etc.

String

ST01
ST03

hierarchicalStructureCode

Hierarchical structure code

String

BHT01

purposeCode

Purpose code

String

BHT02

originatorApplicationTransactionId

Originator application transaction id

String

BHT03

creationDate

Creation date

Date

BHT04

creationTime

Creation time

Time

BHT05

traceIdentifier

Trace identifier

String

TRN02

transactionSetIdentifierCode

Transaction set identifier code

String

ST01

implementationConventionReference

Implementation convention reference

String

ST03

receiptDate

Receipt date

Date

DTP03*050

processDate

Process date

Date

DTP03*009

fileInfo

File info

FileInfo

sender

Information source name

PartyIdName

File Info

Open API Schema
NameDescriptionType

name

File name

String

url

URL of the file, including the full path

String

lastModifiedDateTime

Last modified date and time of the file

Date and Time