HIPAA: 276/277 Claim Status Transaction Updates
June 2, 2004On July 19, 2004, selected field names on the 276/277 Claim Status Request and Response transaction will be updated. These changes are a result of HIPAA. For provider reference, the old field name will pop up when the pointer hovers over a new field name. To access the claim status transaction, providers click the “Perform Claim Status Request” link (formerly named “Perform Claim Status Inquiry”) on the Transaction Services menu. The updated 276/277 transaction maintains claim status information for dates within 12 weeks of the inquiry date. Field name changes are as follows.
Old Field Name |
New Field Name |
CCN |
Payer Claim Control Number |
Recipient ID |
Subscriber Identifier |
Date of Service |
Claim Service Period |
Billed Amount |
Total Claim Charge Amount |
Status Category Code |
Health Care Claim Status Category Code |
Warrant Date |
Check Issue or EFT Effective Date |
Warrant Number |
Check or EFT Trace Number |
Reimbursement Amount |
Claim Payment Amount |
Status Code |
Health Care Claim Status Code |
The following examples show the old and new 276/277 transaction screens.
Example 1. Old
Claim Status Inquiry Screen:
Example 1 with
new HIPAA-updated field names:
Example 2. Old
Claim Status Inquiry Response Screen (Paid Claim):
Example 2 with HIPAA-updated field names (paid
claim):
If a claim is denied, a code number will appear in the Health Care Claim Status Code field. Clicking the code number will open a small screen that displays the old Medi-Cal code and description most similar to the new HIPAA-mandated code. Clicking the Medi-Cal code will open the Medi-Cal provider manual page containing the descriptor for that code. A 276/277 Transactions Code Correlation Table is being developed and will show the relationship between both claim category codes (for example, F1 – Your claim has been paid) and Remittance Advice Details (RAD) codes and the new HIPAA-updated codes. The table will be available on the Medi-Cal Web site by July 19, 2004 and can be accessed through the HIPAA Code Correlations page.