Common X12 Transactions and Descriptions

270 Eligibility Request
271 Eligibility Response

270 eligibility requests are electronic requests for a patient’s benefit and coverage information. The payer returns a 271 response and providing insurance details, including covered dates, patient responsibility amounts, and accumulators.

Claim Status
276 Claim Status Request
277 Claim Status Response

276 claim status requests are sent to the payer to inquire about the status of a claim in process. The payer will return a 277-response providing additional information concerning that claim. Note that this 277 is only sent in response to a 276 request.

Claim & Responses
837 Electronic Claim
TA1 Technical Acknowledgement
999 Initial Acknowlegement
277CA Claim Acknowledgement
835 Claim Payment Remittance

837 is an electronic claim. If an 837 is written with a letter, such as “837P,” the letter indicates the type of claim: P = Professional, I = Institutional, D = Dental. 837s are generated by practice management and hand-entry software systems; the claims are transmitted to a clearinghouse, which delivers the 837 to the payer.

TA1 Acknowledgement is a report on the readability of the file header. Not all payers use TA1s. When a TA1 is included, the report is returned within a few minutes of submission and can accept/reject on the batch level only.

999 reports are automated payer acknowledgements. Some payers send the 999 as a first response to indicate an immediate rejection or an acceptance for further processing. Rejections at the 999 level typically apply to the entire batch (or bundle) of claims that contained the error.

277CA reports are automated claim acknowledgements that show acceptance/rejection information at the claim level. These reports are generated by the payer, and are typically returned within 24-48 hours after submission.

835 Remittance is a payment report. 835s contain the same information as the Explanation of Benefits (EOB) documents traditionally sent by mail, including a detailed breakdown of how much was paid or not paid for each claim. Some practice management systems can use this file to auto-post payments to the correct accounts. 835s are typically received faster than paper EOBs.

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