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 guide will focus on usage of the 277 by a health care payer to provide claim status information on claims pending in the payer's adjudication system without requiring health care provider solicitation. This guide provides a detailed explanation of the transaction set by defining uniform data content and identifying valid code tables and specifying values applicable for the business focus of the Health Care Claim Pending Status Information 277. The intention of the developers of the 277 is represented in the guide.

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Health Care Providers receiving the 277 include, but are not limited to, hospitals, nursing homes, laboratories, physicians, medical group, pharmacies, and suppliers. Organizations sending the 277 include, but are not limited to, insurance companies, third-party administrators, state and federal agencies and their contractors.

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Other business partners affiliated with the 277 include, but are not limited to, billing services, clearinghouses and value-added networks.

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