LocationX331 | Health Care Claim Pending Status Information
1.4 Business Usage
ActionModify Chapter 1
1.4.4.1 STC Composite and Code Use Rules, bulleted item 2.

Removed example with external codes.
CR 1153To clarify intended use.
LocationX331 | Health Care Claim Pending Status Information
1.4 Business Usage
ActionModify Chapter 1
1.4.4.1 STC Composite and Code Use Rules, bulleted item 3.

Removed example with external codes.
CR 1153To clarify intended use.
LocationX331 | Health Care Claim Pending Status Information
1.4 Business Usage
ActionModify Chapter 1
1.4.5 277 Transaction Usages, Figure 1.2, Remove the "997" reference, changed to (999 Acknowledgment)
CR 1118The 997 is no longer appropriate for healthcare transactions and should be removed from the front matter in the Claim Status Guides.  
LocationX331 | Health Care Claim Pending Status Information
1.4 Business Usage
ActionModify Chapter 1
Modify 1.4.3.1 The Claim, Paragraph 1

When conveying claim status, the Information Source must provide key data to the Information Receiver in order to identify the claim to which the status applies. The key identifier used by the Information Receiver for identifying the claim within their system is the Provider's Assigned Claim Identifier. This identifier when submitted on the claim is returned in the Provider's Assigned Claim Identifier REF Segment in the 2200D loop of the 277 transaction.
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX331 | Health Care Claim Pending Status Information
1.5 Business Terminology
ActionAdd Chapter 1
Section 1.5 Business Terminology

Predetermination Status Request

A request for status on a claim that was submitted prior to services being rendered. The predetermination request would include all data necessary to find the predetermination within the payers system, except for date(s) of service. See the 837 TR3 for a definition of a predetermination.
CR 1192Create a definitive method for identifying status requests and responses for pre-determination of benefit claims.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0100
ST - Transaction Set Header
ActionModify Data Element Note
Transaction Set Header/ST02 Transaction Set Control Number

Changed to "The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). For example, start with the number 0001 and increment from there. The number also aids in error resolution research."
CR 999Revise the ST02 notes across the TR3's to make them consistent.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0200
BHT - Beginning of Hierarchical Transaction
ActionAdd Data Element Note
Changed BHT01
Used to specify the sequential order of HL segments. The HL loops in the data stream must comply with this sequential order. An HL parent loop must be followed by any subordinate child loops prior to commencing a new HL parent loop at the same hierarchical level.
CR 1153To clarify intended use.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0100 | 2000A
HL - Information Source Level
ActionModify Data Element Note
Loop ID 2000A/HL01 Element Note

Changed to "The first HL01 within each ST-SE envelope must begin with "1", and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01."
CR 1109For consistency, consider restricting HL01 to numeric values and requiring that enumeration of HL01 begin with 1 and be incremented by 1 for each iteration.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0100 | 2000B
HL - Information Receiver Level
ActionModify Data Element Note
HL01 Changed to "The first HL01 within each ST-SE envelope must begin with "1", and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01."
CR 1109For consistency, consider restricting HL01 to numeric values and requiring that enumeration of HL01 begin with 1 and be incremented by 1 for each iteration.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0100 | 2000C
HL - Service Provider Level
ActionModify Data Element Note
HL01 Changed to "The first HL01 within each ST-SE envelope must begin with "1", and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01."
CR 1109For consistency, consider restricting HL01 to numeric values and requiring that enumeration of HL01 begin with 1 and be incremented by 1 for each iteration.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0500 | 2100C
NM1 - Provider Name
ActionModify Segment Note
Loop ID 2100C / NM1 (Provider Name)

Changed to:
The provider identified facilitates identification of the claim within a payer's system.
CR 389Service Provider NM1: Revise the notes and loop repeat as the NPI mandate is now in effect.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0500 | 2100C
NM1 - Provider Name
ActionModify Segment Repeat
Repeat change from 2 to 1.
CR 389Service Provider NM1: Revise the notes and loop repeat as the NPI mandate is now in effect.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0500 | 2100C
NM1 - Provider Name
ActionModify Data Element Code Note
NM108 - Identification Code Qualifier

XX - Standard Unique Health Identifier for Health Care Providers (NPI)

Changed to "Use when the provider is in the United States or its territories and is eligible to receive a National Provider Identifier (NPI).
OR
Use when the provider is not in the United States or its territories and has received an NPI."
CR 1563Format code notes consistently.
LocationX331 | Health Care Claim Pending Status Information | 277 | 0100 | 2000D
HL - Patient Level
ActionModify Data Element Note
HL01 Changed to "The first HL01 within each ST-SE envelope must begin with "1", and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01."
CR 1109For consistency, consider restricting HL01 to numeric values and requiring that enumeration of HL01 begin with 1 and be incremented by 1 for each iteration.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionModify Data Element Situational Rule
STC01-03, STC10-03, STC11-03
Changed to "Required when an entity must be identified to further clarify the status code in this composite data element. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver."
CR 371Clarify when Claim Status Codes require the transmission of an Entity Code.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionModify Data Element Situational Rule
STC10 and STC11
Changed to "Required when additional status information is needed. If not required by this implementation guide, do not send."
CR 1153To clarify intended use.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionModify Data Element Code Value
Loop ID 2200D / STC01-03 (Entity Type Code)
Standardized (Added/Removed) Entity Type Codes in STC Segment at Claim and Service Levels.
CR 419STC: Standardize use of the same Entity Codes across the TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionAdd Data Element Code Value
O4 - Factor
CR 95The Property & Casualty industry needs the ability to report external entities who purchase accounts receivable assets on behalf of a payer (i.e. Factoring Agent).
LocationX331 | Health Care Claim Pending Status Information | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionAdd Data Element Code Value
OOP - Other Operating Physician
CR 952Replace the ZZ qualifier with an explicit qualifier that identifies Other Operating Physician.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionAdd Data Element
Loop ID 2200D / STC13 (Predetermination of Benefits Code)
CR 1192Create a definitive method for identifying status requests and responses for pre-determination of benefit claims.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1100 | 2200D
REF - Provider's Assigned Claim Identifier
ActionModify Data Element Industry Name
Replace the Industry Name 'Patient Control Number' with 'Provider's Assigned Claim Identifier'.
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1100 | 2200D
REF - Provider's Assigned Claim Identifier
ActionModify Segment Name
From:
Patient control number

To:
Provider's Assigned Claim Identifier
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1100 | 2200D
REF - Provider's Assigned Claim Identifier
ActionModify Segment Situational Rule
Changed To:
Required when the Provider's Assigned Claim Identifier was submitted on the claim. If not required by this implementation guide, do not send.
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1100 | 2200D
REF - Provider's Assigned Claim Identifier
ActionModify Data Element Code Value
X1 - Provider Claim Number
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1100 | 2200D
REF - Provider's Assigned Claim Identifier
ActionAdd Data Element Note
REF02 Reference Identification

This is the value from CLM01 of the 837.
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1100 | 2200D
REF - Provider's Assigned Claim Identifier
ActionAdd Data Element Note
REF02 Reference Identification

The maximum number of characters to be supported for this qualifier is 35. Characters beyond the maximum are not required to be stored or returned by the receiving system.
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1100 | 2200D
REF - Claim Identifier For Transmission Intermediaries
ActionModify Segment Situational Rule
Changed To:
Required when a transmission intermediary (clearinghouse or other) needs to attach their own unique tracking number. If not required by this implementation guide, do not send.
CR 392Create a shared situational rule for REF*D9.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1100 | 2200D
REF - Property & Casualty Claim Number
ActionAdd Segment
Property & Casualty Claim Number
CR 385Support the Property and Casualty industry need for a P&C Claim Number.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1200 | 2200D
DTP - Service Date
ActionModify Segment Note
Update Segment Note:
For Institutional claims, it is the statement period in loop 2300 (DTP01=434). For Professional claims this information is derived from the earliest service level dates in loop 2400 (DTP01=472) to the latest service level date. For Dental claims it is the service date at the claim loop 2300 (DTP01=472) or when not reported at Loop 2300, it is derived from the earliest service level date in loop 2400 (DTP01=472) to the latest service level date.
CR 383Change the usage requirement for the Claim Level Claim Date of Service DTP to situational to support predeterminations.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1200 | 2200D
DTP - Service Date
ActionModify Segment Situational Rule
Update Situational Rule to:
Required when the claim is not a predetermination and service level dates are not reported. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
CR 383Change the usage requirement for the Claim Level Claim Date of Service DTP to situational to support predeterminations.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1800 | 2220D
SVC - Service Line Information
ActionDelete Data Element Code Value
Loop ID 2220D/SVC01-01

WK - Advanced Billing Concepts (ABC) Codes
CR 749Remove support for Advanced Billing Concept Codes (ABC) across the TR3s as HHS has discontinued the associated pilot project.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1800 | 2220D
SVC - Service Line Information
ActionAdd Data Element Note
SVC07 Units of Service Count
Changed To:
"The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. A zero or negative value is not allowed."
CR 1410Negative values are being submitted in the Claim Status Amount and Service Unit data elements of the Claim Status transactions where they do not make business sense. Such negative values should be disallowed.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1800 | 2220D
SVC - Service Line Information
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1800 | 2220D
SVC - Service Line Information
ActionModify Data Element Code Note
HC (Healthcare Common Procedure Coding System (HCPCS) Codes)

Changed to:
Use when reporting HCPCS or CPT codes. AMA's CPT codes are level 1 HCPCS codes, they are reported with an HC qualifier.
CR 1542Improve the consistency of the code value notes within and across the TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionModify Data Element Situational Rule
STC01-03, STC10-03, STC11-03
Changed to "Required when an entity must be identified to further clarify the status code in this composite data element. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver."
CR 371Clarify when Claim Status Codes require the transmission of an Entity Code.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionModify Data Element Situational Rule
STC10 and STC11
Changed to "Required when additional status information is needed. If not required by this implementation guide, do not send."
CR 1153To clarify intended use.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionModify Data Element Code Value
Loop ID 2220D / STC01-03 (Entity Type Code)
Standardized (Added/Removed) Entity Type Codes in STC Segment at Claim and Service Levels.
CR 419STC: Standardize use of the same Entity Codes across the TR3s.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionAdd Data Element Code Value
O4 - Factor.
CR 95The Property & Casualty industry needs the ability to report external entities who purchase accounts receivable assets on behalf of a payer (i.e. Factoring Agent).
LocationX331 | Health Care Claim Pending Status Information | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionAdd Data Element Code Value
OOP - Other Operating Physician
CR 952Replace the ZZ qualifier with an explicit qualifier that identifies Other Operating Physician.
LocationX331 | Health Care Claim Pending Status Information | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionAdd Data Element
Loop ID 2220D / STC13 (Service Line Predetermination of Benefits Code)
CR 1192Create a definitive method for identifying status requests and responses for pre-determination of benefit claims.
LocationX331 | Health Care Claim Pending Status Information | 277 | 2000 | 2220D
REF - Line Item Control Number
ActionModify Segment Name
From: Service Line Item Identification

Changed to:
Line Item Control Number
CR 1539Modify the 2000A REF segment situational rule and the segment name in 275, 276 and 277 guides.
LocationX331 | Health Care Claim Pending Status Information | 277 | 2100 | 2220D
DTP - Service Date
ActionAdd Segment Situational Rule
Required when a service level date was submitted on the claim for this service. If not required by this implementation guide, do not send.
CR 395The Service Line Date of Service is always required, however institutional lines can be reported without a date of service.
LocationX331 | Health Care Claim Pending Status Information | 277 | 2100 | 2220D
DTP - Service Date
ActionModify Segment Usage
Changed from Required to Situational.
CR 395The Service Line Date of Service is always required, however institutional lines can be reported without a date of service.
LocationX331 | Health Care Claim Pending Status Information | 277 | 2150 | 2220D
TOO - Tooth Information
ActionAdd Segment
Loop ID 2220D TOO - TOOTH INFORMATION
CR 1516For consistency across guides.
LocationX331 | Health Care Claim Pending Status Information | 277 | 2700
SE - Transaction Set Trailer
ActionAdd Data Element Note
Transaction Set Trailer / SE02 (Transaction Set Control Number)

The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). For example, start with the number 0001 and increment from there. The number also aids in error resolution research.
CR 999Revise the ST02 notes across the TR3's to make them consistent.