277CA (277 X212) Schema
Claim Status
Status of a single claim. Also contains patient, provider and receiver information.Loop: 2200D JSON Example Interactive Example
| Name | Description | Type | EDI Element |
|---|---|---|---|
| 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 | NM1 *QC Loop: 2100D |
| 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 | NM1 *40 Loop: 2000B |
| receiverBatchStatus | Receiver batch status | BatchStatus | Loop: 2200B |
| provider | Billing provider for 277CA | PartyIdName | NM1 *85 Loop: 2100C |
| providerBatchStatus | Provider batch status | BatchStatus | Loop: 2200C |
| lineStatuses | Rejected service lines | List of ServiceLineStatus | Loop: 2220D |
| transaction | Parent EDI transaction for this object | Transaction |
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.| Name | Description | Type | EDI Element |
|---|---|---|---|
| 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 | Transaction | |
| 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 | NM1 *40 Loop: 2000B |
| receiverBatchStatus | Receiver batch status | BatchStatus | Loop: 2200B |
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.| Name | Description | Type | EDI Element |
|---|---|---|---|
| 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 | Transaction | |
| 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 | NM1 *40 Loop: 2000B |
Service Line Status
Service line information and its statusLoop: 2220D
| Name | Description | Type | EDI Element |
|---|---|---|---|
| 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 InformationSegment: STC
| Name | Description | Type | EDI Element |
|---|---|---|---|
| effectiveDate | Effective date | Date | STC02 |
| actionCode | Action code | String | STC03 |
| actionType | Status action type (action code translated to constant/enum) | 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)| Name | Description | Type | EDI Element |
|---|---|---|---|
| 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 a transaction| Name | Description | Type | EDI Element |
|---|---|---|---|
| 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
| Name | Description | Type | EDI Element |
|---|---|---|---|
| entityRole | Entity role View codes and descriptions | String | NM102, N101 |
| entityType | Type of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for person | String | NM102 |
| identificationType | Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum) | String | NM108, N103 |
| identifier | Identifier | String | NM109, N104 |
| 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 modifiersSegment: HI,SV1,SV2,SVC
| Name | Description | Type | EDI Element |
|---|---|---|---|
| code | Healthcare code | String | |
| desc | Code description | String | |
| modifiers | Modifiers | List of Code | 837P:SV101-3-6, 837I:SV201-3-6, 835:SVC01-3-6 |
Code
Code and description| Name | Description | Type | EDI Element |
|---|---|---|---|
| code | Healthcare code | String | |
| desc | Code description | String |
EDI Transaction Info
| Name | Description | Type | EDI Element |
|---|---|---|---|
| controlNumber | Control number | String | ST02 |
| transactionType | Transaction type translated to string constant, PROF for 837P, INST for 837I, etc. | String | ST01,ST03 |
| purposeCode | Purpose code | String | BHT02 |
| originatorApplicationTransactionId | Originator application transaction id | String | BHT03 |
| creationDate | Creation date | Date | BHT04 |
| creationTime | Creation time | Time | BHT05 |
| originalTransactionSetReferenceNumber | Original transaction set reference number | String | BGN06 |
| actionCode | Action code | String | BGN08 |
| 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 |