X12 276 — Health Care Claim Status Request

Provider inquiry asking a payer for the status of a submitted claim: received, in adjudication, paid, denied, suspended…

Purpose

The 276 replaces calls to the payer's customer service that ask "where is my claim?". It is typically emitted a few days after an 837 when no payment (835) has been received yet. Revenue Cycle Management (RCM) services use it at industrial scale to automate claim follow-up: claims with unknown status after 14 or 21 days are re-checked automatically, and only those needing human action (denied, suspended) are escalated.

Envelope and structure

The 276 uses the standard triple X12 envelope, with GS01 = HR (Health Care Claim Status Request). Like every HIPAA transaction, the ST carries the TR3 identifier (005010X212) as its third element. Example asking about a claim opened two weeks ago:

ISA*00*          *00*          *ZZ*PROVIDER01     *ZZ*PAYER99        *260513*1100*U*00501*000000276*0*P*>~
GS*HR*PROVIDER01*PAYER99*20260513*1100*1*X*005010X212~
ST*276*0001*005010X212~
BHT*0010*13*REQ-CSI-001*20260513*1100~
HL*1**20*1~
NM1*PR*2*PAYER99*****PI*PAYER99~
HL*2*1*21*1~
NM1*41*2*ACME CLINIC*****46*1234567890~
HL*3*2*19*1~
NM1*1P*2*ACME CLINIC*****XX*1234567890~
HL*4*3*22*0~
NM1*IL*1*DOE*JANE****MI*MEMBER12345~
TRN*1*TRACE-CSI-0001*9PROVIDER01~
REF*EJ*CLAIM-REF-9911~
DTP*472*RD8*20260401-20260415~
AMT*T3*620.00~
SE*15*0001~
GE*1*1~
IEA*1*000000276~

Common segments (concept)

• Header — BHT with purpose 13 (request). Four hierarchical HL loop levels: 2000A Information Source (payer), 2000B Information Receiver (the requester), 2000C Service Provider (the physician or facility), 2000D Subscriber, and an optional 2000E Patient.
• Detail — NM1 Individual or Organizational Name at each level, TRN Trace Number tying the 276 to its upcoming 277 response, REF Reference Identification for the claim being looked up (qualifier EJ Patient Account Number, BLT Billing Type Code…), DTP Date or Time or Period for the service window, and AMT Monetary Amount for the billed amount.
• Summary — a single SE.

When you'll see it

The 276 is heavily used by billing services (Athenahealth, Waystar, Optum, R1 RCM) that automate claim follow-up for their provider clients. "Claims without response at day+14" is a standard RCM KPI, and the 276 is what refreshes it before escalation. On the other end, payer CRMs (Salesforce Health Cloud, payer-built) integrate the 276 to match the inquiry against the internal claim record.

Related transactions

• 277 — Health Care Claim Status Response. See 277 page →
• 837 — Health Care Claim (the original claim). See 837 page →
• 835 — Healthcare Claim Payment/Advice. See 835 page →
• 999 — Implementation Acknowledgment. See 999 page →

Documentation

• x12.org/products/transaction-sets — public index, name and code 276.
• stedi.com/edi/x12/transaction-set/276 — public editorial reference, examples.
• cms.gov — HIPAA EDI guides .
• TR3 005010X212 — available for purchase on x12.org or via DISA.