EDI 276 Segments and Elements for the Health Care Claim Status Request Standard


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI276HRHealth Care Claim Status Request InsuranceDownload


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Research and Development:
See the list of EDI 276 segments and elements in below data grid. The Jobisez.com site has an online translation tool that converts the EDI 276 (Health Care Claim Status Request) document into a CSV file. If you are researching the 276s, you can view other trading partner's mapping specifications. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

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The EDI 276 Segments and Elements

SegmentDescriptionSectReqMax LoopMax UsagePos
BHTBeginning Of Hierarchical TransactionHM011
REFReference InformationHO0102
NM1Individual Or Organizational NameHO99999913
N2Additional Name InformationHO024
N3Party LocationHO025
N4Geographic LocationHO016
REFReference InformationHO027
PERAdministrative Communications ContactHO018
HLHierarchical LevelDM99999919
SBRSubscriber InformationDO0110
PATPatient InformationDO0111
DMGDemographic InformationDO0112
NM1Individual Or Organizational NameDO999999113
N3Party LocationDO0214
N4Geographic LocationDO0115
PERAdministrative Communications ContactDO0116
TRNTraceDO999999117
REFReference InformationDO0918
AMTMonetary Amount InformationDO0119
DTPDate Or Time Or PeriodDO0220
SVCService InformationDO999999121
REFReference InformationDO0122
DTPDate Or Time Or PeriodDO0123


SegmentElementDescriptionReqMin LengthMax LengthType
BHT1Hierarchical Structure CodeM44ID
BHT2Transaction Set Purpose CodeM22ID
BHT3Reference IdentificationO150AN
BHT4DateO88DT
BHT5TimeO48TM
BHT6Transaction Type CodeO22ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
HL1Hierarchical Id NumberM112AN
HL2Hierarchical Parent Id NumberO112AN
HL3Hierarchical Level CodeM12ID
HL4Hierarchical Child CodeO11ID
SBR1Payer Responsibility Sequence Number CodeM11ID
SBR2Individual Relationship CodeO22ID
SBR3Reference IdentificationO150AN
SBR4NameO160AN
SBR5Insurance Type CodeO13ID
SBR6Coordination Of Benefits CodeO11ID
SBR7Yes/No Condition Or Response CodeO11ID
SBR8Employment Status CodeO22ID
SBR9Claim Filing Indicator CodeO12ID
PAT1Individual Relationship CodeO22ID
PAT2Patient Location CodeO11ID
PAT3Employment Status CodeO22ID
PAT4Student Status CodeO11ID
PAT5Date Time Period Format QualifierC23ID
PAT6Date Time PeriodC135AN
PAT7Unit Or Basis For Measurement CodeC22ID
PAT8WeightC110R
PAT9Yes/No Condition Or Response CodeO11ID
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
TRN1Trace Type CodeM12ID
TRN2Reference IdentificationM150AN
TRN3Originating Company IdentifierO1010AN
TRN4Reference IdentificationO150AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
SVC1Product/Service Id QualifierM22ID
SVC2Product/Service IdM148AN
SVC3Procedure ModifierM22AN
SVC4Procedure ModifierM22AN
SVC5Procedure ModifierM22AN
SVC6Procedure ModifierM22AN
SVC7DescriptionM180AN
SVC8Product/Service IdM148AN
SVC9Monetary AmountM118R
SVC10Monetary AmountO118R
SVC11Product/Service IdO148AN
SVC12QuantityO115R
SVC13Product/Service Id QualifierO22ID
SVC14Product/Service IdO148AN
SVC15Procedure ModifierO22AN
SVC16Procedure ModifierO22AN
SVC17Procedure ModifierO22AN
SVC18Procedure ModifierO22AN
SVC19DescriptionO180AN
SVC20Product/Service IdO148AN
SVC21QuantityO115R
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN


Official Definition:
Data contents of the Health Care Claim Status Request Transaction Set (276) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used by a provider, recipient of health care products or services, or their authorized agent to request the status of a health care claim or encounter from a health care payer. This transaction set is not intended to replace the Health Care Claim Transaction Set (837), but rather to occur after the receipt of a claim or encounter information. The request may occur at the summary or service line detail level.



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