X12 277CA claim acknowledgment: format and example

277CA structure

The full X12 277CA layout from its OpenEDI definition, the same model ediFabric uses to parse, validate and generate it: 13 loops and 38 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	Information Source Name	Required	1
`NM1`	Information Source Name	Required	1
Loop 2200A	Transmission Receipt Control Identifier	Required	1
`TRN`	Transmission Receipt Control Identifier	Required	1
`DTP`	Information Source Receipt Date	Required	1
`DTP`	Information Source Process Date	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 2200B	Information Receiver Application Trace Identifier	Required	1
`TRN`	Information Receiver Application Trace Identifier	Required	1
`STC`	Information Receiver Status Information	Required	>1
`QTY`	Total Accepted Quantity	Situational	1
`QTY`	Total Rejected Quantity	Situational	1
`AMT`	Total Accepted Amount	Situational	1
`AMT`	Total Rejected Amount	Situational	1
Loop 2000C	Billing Provider of Service Level	Situational	>1
`HL`	Billing Provider of Service Level	Required	1
Loop 2100C	Billing Provider Name	Required	1
`NM1`	Billing Provider Name	Required	1
Loop 2200C	Provider of Service Information Trace Identifier	Situational	1
`TRN`	Provider of Service Information Trace Identifier	Required	1
`STC`	Billing Provider Status Information	Situational	>1
`REF`	Provider Secondary Identifier	Situational	3
`QTY`	Total Accepted Quantity	Situational	1
`QTY`	Total Rejected Quantity	Situational	1
`AMT`	Total Accepted Amount	Situational	1
`AMT`	Total Rejected Amount	Situational	1
Loop 2000D	Patient Level	Situational	>1
`HL`	Patient Level	Required	1
Loop 2100D	Patient Name	Required	1
`NM1`	Patient Name	Required	1
Loop 2200D	Claim Status Tracking Number	Required	>1
`TRN`	Claim Status Tracking Number	Required	1
`STC`	Claim Level Status Information	Required	>1
`REF`	Payer Claim Control Number	Situational	1
`REF`	Claim Identifier for Transmission Intermediaries	Situational	1
`REF`	Institutional Bill Type Identification	Situational	1
`DTP`	Claim Level Service Date	Required	1
Loop 2220D	Service Line Information	Situational	>1
`SVC`	Service Line Information	Required	1
`STC`	Service Line Level Status Information	Required	>1
`REF`	Service Line Item Identification	Required	1
`REF`	Pharmacy Prescription Number	Situational	1
`DTP`	Service Line Date	Required	1
`SE`	Transaction Set Trailer	Required	1

Usage follows the 005010X214 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.

Sample 277CA file

An acknowledgment that accepts one professional claim into adjudication. Paste it into EdiNation to see every element named and validated.

ISA*00*          *00*          *ZZ*RECEIVERID     *ZZ*SUBMITTERID    *260929*1200*^*00501*000000002*0*T*:~
GS*HN*RECEIVERID*SUBMITTERID*20260929*1200*2*X*005010X214~
ST*277*0001*005010X214~
BHT*0085*08*277X2140001*20260929*1200*TH~
HL*1**20*1~
NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666~
TRN*1*0091182~
DTP*050*D8*20260929~
DTP*009*D8*20260929~
HL*2*1*21*1~
NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23~
TRN*2*244579~
STC*A1:19:PR*20260929*WQ*100~
QTY*90*1~
AMT*YU*100~
HL*3*2*19*1~
NM1*85*2*BEN KILDARE SERVICE*****XX*9876543210~
HL*4*3*PT~
NM1*QC*1*SMITH*TED****MI*000221111A~
TRN*2*26463774~
STC*A2:20:PR*20260929*WQ*100~
REF*1K*2026272000001~
DTP*472*RD8*20260920-20260920~
SE*22*0001~
GE*1*2~
IEA*1*000000002~

The same 277CA as JSON

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": "277",
    "TransactionSetControlNumber_02": "0001",
    "ImplementationConventionPreference_03": "005010X214"
  },
  "BHT_BeginningOfHierarchicalTransaction": {
    "HierarchicalStructureCode_01": "0085",
    "TransactionSetPurposeCode_02": "08",
    "SubmitterTransactionIdentifier_03": "277X2140001",
    "TransactionSetCreationDate_04": "20260929",
    "TransactionSetCreationTime_05": "1200",
    "TransactionTypeCode_06": "TH"
  },
  "Loop2000A": {
    "HL_InformationSourceLevel": {
      "HierarchicalIDNumber_01": "1",
      "HierarchicalLevelCode_03": "20",
      "HierarchicalChildCode_04": "1"
    },
    "Loop2100A": {
      "NM1_InformationSourceName": {
        "EntityIdentifierCode_01": "PR",
        "EntityTypeQualifier_02": "2",
        "ResponseContactLastorOrganizationName_03": "KEY INSURANCE COMPANY",
        "IdentificationCodeQualifier_08": "PI",
        "ResponseContactIdentifier_09": "999996666"
      }
    },
    "Loop2200A": {
      "TRN_TransmissionReceiptControlIdentifier": {
        "TraceTypeCode_01": "1",
        "CurrentTransactionTraceNumber_02": "0091182"
      },
      "DTP_InformationSourceReceiptDate": {
        "DateTimeQualifier_01": "050",
        "DateTimePeriodFormatQualifier_02": "D8",
        "DateTimePeriod_03": "20260929"
      },
      "DTP_InformationSourceProcessDate": {
        "DateTimeQualifier_01": "009",
        "DateTimePeriodFormatQualifier_02": "D8",
        "DateTimePeriod_03": "20260929"
      }
    },
    "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": "PREMIER BILLING SERVICE",
          "IdentificationCodeQualifier_08": "46",
          "ResponseContactIdentifier_09": "TGJ23"
        }
      },
      "Loop2200B": {
        "TRN_InformationReceiverApplicationTraceIdentifier": {
          "TraceTypeCode_01": "2",
          "CurrentTransactionTraceNumber_02": "244579"
        },
        "STC_InformationReceiverStatusInformation": [
          {
            "HealthCareClaimStatus_01": {
              "HealthCareClaimStatusCategoryCode_01": "A1",
              "StatusCode_02": "19",
              "EntityIdentifierCode_03": "PR"
            },
            "Date_02": "20260929",
            "ActionCode_03": "WQ",
            "TotalSubmittedChargesForUnitWork_04": "100"
          }
        ],
        "QTY_TotalAcceptedQuantity": {
          "QuantityQualifier_01": "90",
          "AmbulancePatientCount_02": "1"
        },
        "AMT_TotalAcceptedAmount": {
          "AmountQualifierCode_01": "YU",
          "TotalClaimChargeAmount_02": "100"
        }
      },
      "Loop2000C": [
        {
          "HL_BillingProviderOfServiceLevel": {
            "HierarchicalIDNumber_01": "3",
            "HierarchicalParentIDNumber_02": "2",
            "HierarchicalLevelCode_03": "19",
            "HierarchicalChildCode_04": "1"
          },
          "Loop2100C": {
            "NM1_BillingProviderName": {
              "EntityIdentifierCode_01": "85",
              "EntityTypeQualifier_02": "2",
              "ResponseContactLastorOrganizationName_03": "BEN KILDARE SERVICE",
              "IdentificationCodeQualifier_08": "XX",
              "ResponseContactIdentifier_09": "9876543210"
            }
          },
          "Loop2000D": [
            {
              "HL_PatientLevel": {
                "HierarchicalIDNumber_01": "4",
                "HierarchicalParentIDNumber_02": "3",
                "HierarchicalLevelCode_03": "PT"
              },
              "Loop2100D": {
                "NM1_PatientName": {
                  "EntityIdentifierCode_01": "QC",
                  "EntityTypeQualifier_02": "1",
                  "ResponseContactLastorOrganizationName_03": "SMITH",
                  "ResponseContactFirstName_04": "TED",
                  "IdentificationCodeQualifier_08": "MI",
                  "ResponseContactIdentifier_09": "000221111A"
                }
              },
              "Loop2200D": [
                {
                  "TRN_ClaimStatusTrackingNumber": {
                    "TraceTypeCode_01": "2",
                    "CurrentTransactionTraceNumber_02": "26463774"
                  },
                  "STC_ClaimLevelStatusInformation": [
                    {
                      "HealthCareClaimStatus_01": {
                        "HealthCareClaimStatusCategoryCode_01": "A2",
                        "StatusCode_02": "20",
                        "EntityIdentifierCode_03": "PR"
                      },
                      "Date_02": "20260929",
                      "ActionCode_03": "WQ",
                      "TotalSubmittedChargesForUnitWork_04": "100"
                    }
                  ],
                  "REF_PayerClaimControlNumber": {
                    "ReferenceIdentificationQualifier_01": "1K",
                    "MemberGrouporPolicyNumber_02": "2026272000001"
                  },
                  "DTP_ClaimLevelServiceDate": {
                    "DateTimeQualifier_01": "472",
                    "DateTimePeriodFormatQualifier_02": "RD8",
                    "DateTimePeriod_03": "20260920-20260920"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  },
  "SE": {
    "NumberofIncludedSegments_01": "22",
    "TransactionSetControlNumber_02": "0001"
  }
}

Parse and validate a 277CA file

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.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

using (var stream = File.OpenRead(@"C:\edi\277CA.txt"))
using (var reader = new X12Reader(stream, "EdiFabric.Templates.Hipaa"))
{
    var items = await reader.ReadToEndAsync();
    foreach (var transaction in items.OfType<TS277A>())
    {
        if (transaction.IsValid(out MessageErrorContext errors))
            Console.WriteLine($"{transaction.ST.TransactionSetControlNumber_02} is valid");
        else
            Console.WriteLine(string.Join(Environment.NewLine, errors.Flatten()));
    }
} Install and get started 277CA example project Walkthrough
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("277CA.txt", "rb").read()
output, offset = ef.parse(edi, ef.ParseMode.JSON_VALIDATE)
transactions = output[:offset]
report = json.loads(output[offset:])
print(report["errors_count"]) Python bindingsediFabric Native
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("277CA.txt"));
ParseResult result = EdiFabricX12.parse(edi, ParseMode.JSON_VALIDATE);
System.out.println(result.getTransactions());
System.out.println(result.getReport()); Java bindingsediFabric Native
#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("277CA.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);
} C bindingsediFabric Native
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 '@277CA.txt' TranslateValidateediFabric Cloud

Generate a 277CA file

Populate a TS277A object in .NET, or pass JSON in the shape shown above to ediFabric Native or ediFabric Cloud, and get a valid 277CA file back.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

var transaction = new TS277A();

//  Claim acknowledgment transaction set header
transaction.ST = new ST();
transaction.ST.TransactionSetIdentifierCode_01 = "277";
transaction.ST.TransactionSetControlNumber_02 = "0001";
transaction.ST.ImplementationConventionPreference_03 = "005010X214";

//  Information source acknowledgment created on September 29, 2026
transaction.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_5();
transaction.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0085";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "08";
transaction.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "277X2140001";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20260929";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1200";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionTypeCode_06 = "TH";

//  Begin 2000A Loop INFORMATION SOURCE LEVEL
transaction.Loop2000A = new List<Loop_2000A_277A>();
var loop2000A = new Loop_2000A_277A();
loop2000A.HL_InformationSourceLevel = new HL_BillingProviderHierarchicalLevel();
loop2000A.HL_InformationSourceLevel.HierarchicalIDNumber_01 = "1";
loop2000A.HL_InformationSourceLevel.HierarchicalLevelCode_03 = "20";
loop2000A.HL_InformationSourceLevel.HierarchicalChildCode_04 = "1";
transaction.Loop2000A.Add(loop2000A);

// ... 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", "005010X214"));
        writer.Write(transaction);
    }
    Console.WriteLine(Encoding.UTF8.GetString(stream.ToArray()));
} Install and get started Full 277CA build methodExample repository
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("277CA.json", "rb").read()
edi = ef.build(transactions, postfix="\r\n")
print(edi) Python bindings
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("277CA.json"));
String edi = EdiFabricX12.build(transactions, "\r\n");
System.out.println(edi); Java bindings
#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("277CA.json", NULL);
if (ef_build(transactions, "\r\n", &edi) == 0) {
    fwrite(edi.data, 1, (size_t)edi.length, stdout);
    ef_free(edi.data);
} C bindings
# 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 '@277CA.json' \
-o '277CA.txt' How-tosediFabric Cloud

277CA questions

What is the difference between the 999 and the 277CA?

The 999 reports whether the 837 file is structurally valid against the implementation guide. The 277CA comes after and reports business-level acceptance or rejection of each claim.

How do I read the claim status in a 277CA?

STC01 is a composite of category code, status code and entity. Category A1 is an acknowledgment of receipt, A2 acceptance into adjudication, A3 returned as unprocessable, A7 rejected for invalid information.

Is the 277CA the same as the 277 claim status response?

No. Both use ST*277, but the 277CA (005010X214) acknowledges submitted claims, while the 277 (005010X212) answers a 276 status request.

How do I parse and generate X12 277CA files in .NET, Python, Java and C?

In .NET, install EdiFabric and EdiFabric.Templates.Hipaa, read the file with X12Reader into TS277A objects and write them back with X12Writer. From Python, Java or C, use ediFabric Native, which converts 277CA files to JSON and JSON back to X12 inside your process. From any other language, post the file to the ediFabric Cloud REST API.

Related transactions

X12 837P - Health Care Claim: Professional
X12 837I - Health Care Claim: Institutional
X12 277 - Health Care Claim Status Response
X12 835 - Health Care Claim Payment/Advice
All EDI transactions →

X12 277CA Health Care Claim Acknowledgment

At a glance