Administrative Simplification Basics Series:

Claim Status Transaction

Administrative Simplification includes standards for administrative and financial electronic health care transactions. Widespread use of these standards—where all trading partners use the same format and codes—can lead to substantial savings for health care organizations.

Today, we’ll review one of these transactions: the claim status inquiry and response paired transactions, also known as the X12 276/277 transaction sets.

Who Uses Claim Status Transactions?

A claim status transaction is used for:

An inquiry from a provider to a health plan about the status of a health care claim
A response from a health plan to a provider about the status of a claim

The goal of standardized claim status transactions is to make it easier to determine the status of claims. Visit the claim status page of the CMS Administrative Simplification website to learn more.