Chapter 1. Purpose and Business Information

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1.1 Implementation Purpose and Scope

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For the health care industry to achieve the potential administrative cost savings with Electronic Data Interchange (EDI), standards have been developed to facilitate consistent implementation by all organizations. To facilitate a smooth transition into the EDI environment, uniform implementation is critical.

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The purpose of this implementation guide is to provide standardized data requirements and content for all users of ASC X12, Health Care Information Status Notification (277). This implementation guide focuses on the use of the 277 as an acknowledgment of receipt of claim submission(s). This implementation guide provides a detailed explanation of the transaction set by defining uniform data content, identifying valid code tables and specifying values applicable for the business focus of the 277 claim submission acknowledgment. The intention of the developers of the 277 is represented in this guide.

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Entities receiving this application of the 277 include, but are not limited to, hospitals, nursing homes, laboratories, physicians, dentists, allied health professional groups, employers and supplemental (i.e., other than primary payer) health care claims adjudication processors.

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Organizations sending this application of the 277 include payers, who may be insurance companies; Third Party Administrators (TPA); service corporations; state and federal agencies and their contractors; plan purchasers; and any other entity that processes health care claims.

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Other business partners affiliated with the 277 include billing services; consulting services; vendors of systems; software and EDI translators; and EDI network intermediaries such as health care clearinghouses, value-added networks and telecommunication services.

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