The 276 (005010X212) is the HIPAA transaction a provider sends to ask a payer about the status of one or more submitted claims. The payer answers with a 277.
The request identifies the payer, the provider, the subscriber and dependent, and each claim with its patient control number, charge amount and dates of service.
005010X212HR (GS01)TS276 in EdiFabric.Templates.HipaaThe full X12 276 layout from its OpenEDI definition, the same model ediFabric uses to parse, validate and generate it: 14 loops and 41 segment positions, in file order. Loops are shaded and their segments indented; Max use is how many times a segment or loop may repeat.
| Segment / loop | Name | Usage | Max use |
|---|---|---|---|
ST | Transaction Set Header | Required | 1 |
BHT | Beginning of Hierarchical Transaction | Required | 1 |
| Loop 2000A | Information Source Level | Required | >1 |
HL | Information Source Level | Required | 1 |
| Loop 2100A | Payer Name | Required | 1 |
NM1 | Payer Name | Required | 1 |
| Loop 2000B | Information Receiver Level | Required | >1 |
HL | Information Receiver Level | Required | 1 |
| Loop 2100B | Information Receiver Name | Required | 1 |
NM1 | Information Receiver Name | Required | 1 |
| Loop 2000C | Service Provider Level | Required | >1 |
HL | Service Provider Level | Required | 1 |
| Loop 2100C | Provider Name | Required | 2 |
NM1 | Provider Name | Required | 1 |
| Loop 2000D | Subscriber Level | Required | >1 |
HL | Subscriber Level | Required | 1 |
DMG | Subscriber Demographic Information | Situational | 1 |
| Loop 2100D | Subscriber Name | Required | 1 |
NM1 | Subscriber Name | Required | 1 |
| Loop 2200D | Claim Status Tracking Number | Situational | >1 |
TRN | Claim Status Tracking Number | Required | 1 |
| Any order | The loops below can appear in any order | Situational | 1 |
REF | Payer Claim Control Number | Situational | 1 |
REF | Institutional Bill Type Identification | Situational | 1 |
REF | Applicationor Location System Identifier | Situational | 1 |
REF | Group Number | Situational | 1 |
REF | Patient Control Number | Situational | 1 |
REF | Pharmacy Prescription Number | Situational | 1 |
REF | Claim Identification Number for Clearinghouses and Other Transmission Intermediaries | Situational | 1 |
AMT | Claim Submitted Charges | Situational | 1 |
DTP | Claim Service Date | Situational | 1 |
| Loop 2210D | Service Line Information | Situational | >1 |
SVC | Service Line Information | Required | 1 |
REF | Service Line Item Identification | Situational | 1 |
DTP | Service Line Date | Required | 1 |
| Loop 2000E | Dependent Level | Situational | >1 |
HL | Dependent Level | Required | 1 |
DMG | Dependent Demographic Information | Required | 1 |
| Loop 2100E | Dependent Name | Required | 1 |
NM1 | Dependent Name | Required | 1 |
| Loop 2200E | Claim Status Tracking Number | Required | >1 |
TRN | Claim Status Tracking Number | Required | 1 |
| Any order | The loops below can appear in any order | Situational | 1 |
REF | Payer Claim Control Number | Situational | 1 |
REF | Institutional Bill Type Identification | Situational | 1 |
REF | Applicationor Location System Identifier | Situational | 1 |
REF | Group Number | Situational | 1 |
REF | Patient Control Number | Situational | 1 |
REF | Pharmacy Prescription Number | Situational | 1 |
REF | Claim Identification Number for Clearinghouses and Other Transmission Intermediaries | Situational | 1 |
AMT | Claim Submitted Charges | Situational | 1 |
DTP | Claim Service Date | Situational | 1 |
| Loop 2210E | Service Line Information | Situational | >1 |
SVC | Service Line Information | Required | 1 |
REF | Service Line Item Identification | Situational | 1 |
DTP | Service Line Date | Required | 1 |
SE | Transaction Set Trailer | Required | 1 |
Usage follows the 005010X212 implementation guide: Required segments must be sent, Situational ones only when the guide's condition applies. Trading partners often add their own rules in companion guides - ediFabric templates can be adjusted to match. Open the element-level definition in the EdiNation spec library.
A claim status request for claims under one provider. Paste it into EdiNation to see every element named and validated.
ISA*00* *00* *ZZ*1234567 *ZZ*11111 *170508*1141*^*00501*000000101*1*P*:~ GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X212~ ST*276*0001*005010X212~ BHT*0010*13*ABC276XXX*20050915*1425~ HL*1**20*1~ NM1*PR*2*ABC INSURANCE*****PI*12345~ HL*2*1*21*1~ NM1*41*2*XYZ SERVICE*****46*X67E~ HL*3*2*19*1~ NM1*1P*2*HOME HOSPITAL*****XX*1666666661~ HL*4*3*22*0~ DMG*D8*19301210*M~ NM1*IL*1*SMITH*FRED****MI*123456789A~ TRN*1*ABCXYZ1~ REF*BLT*111~ REF*EJ*SM123456~ AMT*T3*8513.88~ DTP*472*RD8*20050831-20050906~ HL*5*3*22*0~ DMG*D8*19301115*F~ NM1*IL*1*JONES*MARY****MI*234567890A~ TRN*1*ABCXYZ2~ REF*BLT*111~ REF*EJ*JO234567~ AMT*T3*7599~ DTP*472*RD8*20050731-20050809~ HL*6*2*19*1~ NM1*1P*2*HOME HOSPITAL PHYSICIANS*****XX*1666666666~ HL*7*6*22*1~ NM1*IL*1*MANN*JOHN****MI*345678901~ HL*8*7*23~ DMG*D8*19951101*M~ NM1*QC*1*MANN*JOSEPH~ TRN*1*ABCXYZ3~ REF*EJ*MA345678~ SVC*HC:99203*150*****1~ DTP*472*D8*20050501~ SE*36*0001~ GE*1*101~ IEA*1*000000101~
ediFabric turns every loop, segment and element into a named field. This is the transaction from the sample, in the JSON that ediFabric Native and Cloud return and accept.
{
"ST": {
"TransactionSetIdentifierCode_01": "276",
"TransactionSetControlNumber_02": "0001",
"ImplementationConventionPreference_03": "005010X212"
},
"BHT_BeginningOfHierarchicalTransaction": {
"HierarchicalStructureCode_01": "0010",
"TransactionSetPurposeCode_02": "13",
"SubmitterTransactionIdentifier_03": "ABC276XXX",
"TransactionSetCreationDate_04": "20050915",
"TransactionSetCreationTime_05": "1425"
},
"Loop2000A": [
{
"HL_InformationSourceLevel": {
"HierarchicalIDNumber_01": "1",
"HierarchicalLevelCode_03": "20",
"HierarchicalChildCode_04": "1"
},
"Loop2100A": {
"NM1_PayerName": {
"EntityIdentifierCode_01": "PR",
"EntityTypeQualifier_02": "2",
"ResponseContactLastorOrganizationName_03": "ABC INSURANCE",
"IdentificationCodeQualifier_08": "PI",
"ResponseContactIdentifier_09": "12345"
}
},
"Loop2000B": [
{
"HL_InformationReceiverLevel": {
"HierarchicalIDNumber_01": "2",
"HierarchicalParentIDNumber_02": "1",
"HierarchicalLevelCode_03": "21",
"HierarchicalChildCode_04": "1"
},
"Loop2100B": {
"NM1_InformationReceiverName": {
"EntityIdentifierCode_01": "41",
"EntityTypeQualifier_02": "2",
"ResponseContactLastorOrganizationName_03": "XYZ SERVICE",
"IdentificationCodeQualifier_08": "46",
"ResponseContactIdentifier_09": "X67E"
}
},
"Loop2000C": [
{
"HL_ServiceProviderLevel": {
"HierarchicalIDNumber_01": "3",
"HierarchicalParentIDNumber_02": "2",
"HierarchicalLevelCode_03": "19",
"HierarchicalChildCode_04": "1"
},
"Loop2100C": [
{
"NM1_ProviderName": {
"EntityIdentifierCode_01": "1P",
"EntityTypeQualifier_02": "2",
"ResponseContactLastorOrganizationName_03": "HOME HOSPITAL",
"IdentificationCodeQualifier_08": "XX",
"ResponseContactIdentifier_09": "1666666661"
}
}
],
"Loop2000D": [
{
"HL_SubscriberLevel": {
"HierarchicalIDNumber_01": "4",
"HierarchicalParentIDNumber_02": "3",
"HierarchicalLevelCode_03": "22",
"HierarchicalChildCode_04": "0"
},
"DMG_SubscriberDemographicInformation": {
"DateTimePeriodFormatQualifier_01": "D8",
"DependentBirthDate_02": "19301210",
"DependentGenderCode_03": "M"
},
"Loop2100D": {
"NM1_SubscriberName": {
"EntityIdentifierCode_01": "IL",
"EntityTypeQualifier_02": "1",
"ResponseContactLastorOrganizationName_03": "SMITH",
"ResponseContactFirstName_04": "FRED",
"IdentificationCodeQualifier_08": "MI",
"ResponseContactIdentifier_09": "123456789A"
}
},
"Loop2200D": [
{
"TRN_ClaimStatusTrackingNumber": {
"TraceTypeCode_01": "1",
"CurrentTransactionTraceNumber_02": "ABCXYZ1"
},
"AllREF": {
"REF_InstitutionalBillTypeIdentification": {
"ReferenceIdentificationQualifier_01": "BLT",
"MemberGrouporPolicyNumber_02": "111"
},
"REF_PatientControlNumber": {
"ReferenceIdentificationQualifier_01": "EJ",
"MemberGrouporPolicyNumber_02": "SM123456"
}
},
"AMT_ClaimSubmittedCharges": {
"AmountQualifierCode_01": "T3",
"TotalClaimChargeAmount_02": "8513.88"
},
"DTP_ClaimServiceDate": {
"DateTimeQualifier_01": "472",
"DateTimePeriodFormatQualifier_02": "RD8",
"DateTimePeriod_03": "20050831-20050906"
}
}
]
},
{
"HL_SubscriberLevel": {
"HierarchicalIDNumber_01": "5",
"HierarchicalParentIDNumber_02": "3",
"HierarchicalLevelCode_03": "22",
"HierarchicalChildCode_04": "0"
},
"DMG_SubscriberDemographicInformation": {
"DateTimePeriodFormatQualifier_01": "D8",
"DependentBirthDate_02": "19301115",
"DependentGenderCode_03": "F"
},
"Loop2100D": {
"NM1_SubscriberName": {
"EntityIdentifierCode_01": "IL",
"EntityTypeQualifier_02": "1",
"ResponseContactLastorOrganizationName_03": "JONES",
"ResponseContactFirstName_04": "MARY",
"IdentificationCodeQualifier_08": "MI",
"ResponseContactIdentifier_09": "234567890A"
}
},
"Loop2200D": [
{
"TRN_ClaimStatusTrackingNumber": {
"TraceTypeCode_01": "1",
"CurrentTransactionTraceNumber_02": "ABCXYZ2"
},
"AllREF": {
"REF_InstitutionalBillTypeIdentification": {
"ReferenceIdentificationQualifier_01": "BLT",
"MemberGrouporPolicyNumber_02": "111"
},
"REF_PatientControlNumber": {
"ReferenceIdentificationQualifier_01": "EJ",
"MemberGrouporPolicyNumber_02": "JO234567"
}
},
"AMT_ClaimSubmittedCharges": {
"AmountQualifierCode_01": "T3",
"TotalClaimChargeAmount_02": "7599"
},
"DTP_ClaimServiceDate": {
"DateTimeQualifier_01": "472",
"DateTimePeriodFormatQualifier_02": "RD8",
"DateTimePeriod_03": "20050731-20050809"
}
}
]
}
]
},
{
"HL_ServiceProviderLevel": {
"HierarchicalIDNumber_01": "6",
"HierarchicalParentIDNumber_02": "2",
"HierarchicalLevelCode_03": "19",
"HierarchicalChildCode_04": "1"
},
"Loop2100C": [
{
"NM1_ProviderName": {
"EntityIdentifierCode_01": "1P",
"EntityTypeQualifier_02": "2",
"ResponseContactLastorOrganizationName_03": "HOME HOSPITAL PHYSICIANS",
"IdentificationCodeQualifier_08": "XX",
"ResponseContactIdentifier_09": "1666666666"
}
}
],
"Loop2000D": [
{
"HL_SubscriberLevel": {
"HierarchicalIDNumber_01": "7",
"HierarchicalParentIDNumber_02": "6",
"HierarchicalLevelCode_03": "22",
"HierarchicalChildCode_04": "1"
},
"Loop2100D": {
"NM1_SubscriberName": {
"EntityIdentifierCode_01": "IL",
"EntityTypeQualifier_02": "1",
"ResponseContactLastorOrganizationName_03": "MANN",
"ResponseContactFirstName_04": "JOHN",
"IdentificationCodeQualifier_08": "MI",
"ResponseContactIdentifier_09": "345678901"
}
},
"Loop2000E": [
{
"HL_DependentLevel": {
"HierarchicalIDNumber_01": "8",
"HierarchicalParentIDNumber_02": "7",
"HierarchicalLevelCode_03": "23"
},
"DMG_DependentDemographicInformation": {
"DateTimePeriodFormatQualifier_01": "D8",
"DependentBirthDate_02": "19951101",
"DependentGenderCode_03": "M"
},
"Loop2100E": {
"NM1_DependentName": {
"EntityIdentifierCode_01": "QC",
"EntityTypeQualifier_02": "1",
"ResponseContactLastorOrganizationName_03": "MANN",
"ResponseContactFirstName_04": "JOSEPH"
}
},
"Loop2200E": [
{
"TRN_ClaimStatusTrackingNumber": {
"TraceTypeCode_01": "1",
"CurrentTransactionTraceNumber_02": "ABCXYZ3"
},
"AllREF": {
"REF_PatientControlNumber": {
"ReferenceIdentificationQualifier_01": "EJ",
"MemberGrouporPolicyNumber_02": "MA345678"
}
},
"Loop2210E": [
{
"SVC_ServiceLineInformation": {
"CompositeMedicalProcedureIdentifier_01": {
"ProductorServiceIDQualifier_01": "HC",
"ProcedureCode_02": "99203"
},
"LineItemChargeAmount_02": "150",
"UnitsofServiceCount_07": "1"
},
"DTP_ServiceLineDate": {
"DateTimeQualifier_01": "472",
"DateTimePeriodFormatQualifier_02": "D8",
"DateTimePeriod_03": "20050501"
}
}
]
}
]
}
]
}
]
}
]
}
]
}
],
"SE": {
"NumberofIncludedSegments_01": "36",
"TransactionSetControlNumber_02": "0001"
}
}Read the file into typed objects with ediFabric .NET, convert it to JSON in process with the ediFabric Native bindings for Python, Java and C, or post it to the ediFabric Cloud REST API from any language.
using EdiFabric.Templates.Hipaa5010; License.SetSerial("YOUR_SERIAL_KEY"); using (var stream = File.OpenRead(@"C:\edi\RequestTransmission.txt")) using (var reader = new X12Reader(stream, "EdiFabric.Templates.Hipaa")) { var items = await reader.ReadToEndAsync(); foreach (var transaction in items.OfType<TS276>()) { if (transaction.IsValid(out MessageErrorContext errors)) Console.WriteLine($"{transaction.ST.TransactionSetControlNumber_02} is valid"); else Console.WriteLine(string.Join(Environment.NewLine, errors.Flatten())); } }
import json import edifabric_x12 as ef serial = "YOUR_SERIAL_KEY" ef.load_library() ef.set_serial(serial) ef.set_map(json.dumps({"default": serial, "maps": {}})) edi = open("RequestTransmission.txt", "rb").read() output, offset = ef.parse(edi, ef.ParseMode.JSON_VALIDATE) transactions = output[:offset] report = json.loads(output[offset:]) print(report["errors_count"])
import com.edifabric.nativex12.EdiFabricX12; import com.edifabric.nativex12.ParseMode; import com.edifabric.nativex12.ParseResult; String serial = "YOUR_SERIAL_KEY"; EdiFabricX12.loadLibrary(); EdiFabricX12.setSerial(serial); EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}"); String edi = Files.readString(Path.of("RequestTransmission.txt")); ParseResult result = EdiFabricX12.parse(edi, ParseMode.JSON_VALIDATE); System.out.println(result.getTransactions()); System.out.println(result.getReport());
#include "edifabric_x12.h" const char *serial = "YOUR_SERIAL_KEY"; ef_parse_result result; if (ef_load_library(NULL) != 0) return 1; ef_set_serial(serial); ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}"); char *edi = read_file("RequestTransmission.txt", NULL); /* helper in example_all_functions.c */ if (ef_parse(edi, EF_PARSE_JSON_VALIDATE, NULL, &result) == 0) { /* transactions = output[0 .. offset), report = output[offset .. length) */ fwrite(result.output.data, 1, (size_t)result.output.length, stdout); ef_free(result.output.data); }
curl -X POST 'https://api.edination.com/v2/x12/read' \ -H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \ -H 'Content-Type: application/octet-stream' \ --data-binary '@RequestTransmission.txt'
Populate a TS276 object in .NET, or pass JSON in the shape shown above to ediFabric Native or ediFabric Cloud, and get a valid 276 file back.
using EdiFabric.Templates.Hipaa5010; License.SetSerial("YOUR_SERIAL_KEY"); var transaction = new TS276(); transaction.ST = new ST(); transaction.ST.TransactionSetIdentifierCode_01 = "276"; transaction.ST.TransactionSetControlNumber_02 = "0001"; transaction.ST.ImplementationConventionPreference_03 = "005010X212"; transaction.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_3(); transaction.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0010"; transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "13"; transaction.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "ABC276XXX"; transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20050915"; transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1425"; // Repeating 2000A Loops transaction.Loop2000A = new List<Loop_2000A_276>(); // Begin 2000A Loop var loop2000A = new Loop_2000A_276(); // ... set the remaining loops and segments the same way // SegmentBuilders is in the Common project of the example repository using (var stream = new MemoryStream()) { using (var writer = new X12Writer(stream)) { writer.Write(SegmentBuilders.BuildIsa("1")); writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X212")); writer.Write(transaction); } Console.WriteLine(Encoding.UTF8.GetString(stream.ToArray())); }
import json import edifabric_x12 as ef serial = "YOUR_SERIAL_KEY" ef.load_library() ef.set_serial(serial) ef.set_map(json.dumps({"default": serial, "maps": {}})) # the transactions JSON returned by ef.parse, edited or produced by your application transactions = open("RequestTransmission.json", "rb").read() edi = ef.build(transactions, postfix="\r\n") print(edi)
import com.edifabric.nativex12.EdiFabricX12; String serial = "YOUR_SERIAL_KEY"; EdiFabricX12.loadLibrary(); EdiFabricX12.setSerial(serial); EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}"); // the transactions JSON returned by parse, edited or produced by your application String transactions = Files.readString(Path.of("RequestTransmission.json")); String edi = EdiFabricX12.build(transactions, "\r\n"); System.out.println(edi);
#include "edifabric_x12.h" ef_buffer edi; if (ef_load_library(NULL) != 0) return 1; ef_set_serial("YOUR_SERIAL_KEY"); ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}"); /* the transactions JSON returned by ef_parse, edited or produced by your application */ char *transactions = read_file("RequestTransmission.json", NULL); if (ef_build(transactions, "\r\n", &edi) == 0) { fwrite(edi.data, 1, (size_t)edi.length, stdout); ef_free(edi.data); }
# the JSON returned by /read, edited or produced by your application curl -X POST 'https://api.edination.com/v2/x12/write' \ -H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \ -H 'Content-Type: application/json' \ --data-binary '@RequestTransmission.json' \ -o 'RequestTransmission.txt'
A 277 claim status response (005010X212) with an STC status for each claim, and a 999 for the file.
By the TRN trace number, the patient control number in REF, the claim charge amount in AMT and the service dates in DTP. The payer's claim number can be sent in REF*1K when known.
Payers publish limits. The 277CA and the 835 already report acceptance and payment, so a 276 is usually sent only when a claim has not been reported within the expected time.
In .NET, install EdiFabric and EdiFabric.Templates.Hipaa, read the file with X12Reader into TS276 objects and write them back with X12Writer. From Python, Java or C, use ediFabric Native, which converts 276 files to JSON and JSON back to X12 inside your process. From any other language, post the file to the ediFabric Cloud REST API.