Contents of the Claim Status Response Body

Consult the OpenAPI 3.0 JSON specification for our EDI 276 Claim Status submission for more details on the Change Healthcare Claim Status API.

Claim Status responses provide full breakdowns of all the line items in the claim.

Each line item, in a professional claim for example, is represented in a serviceLine record within the claim. Claim Status lists the end-result payoffs for each submitted serviceLine in a claimStatus object. This applies for both Professional claims and Institutional claims.

The Sandbox version of the API shows a list of several such claimStatus objects as follows. Each object contains a series of codes and code explanations that originate from the payer system. They follow the industry standards in the EDI 277 response:

{
    "controlNumber": "000000001",
    "tradingPartnerServiceId": "serviceId",
    "payer": {
        "organizationName": "Unknown",
        "payerIdentification": "serviceId",
        "contactInformation": {}
    },
    "providers": [
        {
            "organizationName": "TestProvider",
            "taxId": "0123456789",
            "providerType": "BillingProvider"
        },
        {
            "organizationName": "happy doctors group",
            "npi": "1760854442",
            "providerType": "ServiceProvider"
        }
    ],
    "subscriber": {
        "firstName": "johnone",
        "lastName": "doeone",
        "memberId": "0000000000"
    },
    "claims": [
        {
            "claimStatus": {
                "statusCategoryCode": "F1",
                "statusCategoryCodeValue": "Finalized/Payment-The claim/line has been paid.",
                "statusCode": "65",
                "statusCodeValue": "Claim/line has been paid.",
                "entityCode": "1E",
                "entity": "Health Maintenance Organization (HMO)",
                "effectiveDate": "20170415",
                "submittedAmount": "1229",
                "amountPaid": "219",
                "paidDate": "20170415",
                "checkIssueDate": "20170415",
                "checkNumber": "1111111",
                "trackingNumber": "000000001",
                "claimServiceDate": "20160722",
                "tradingPartnerClaimNumber": "AAAAAAAAAAA1"
            }
        },
        {
            "claimStatus": {
                "statusCategoryCode": "F3",
                "statusCategoryCodeValue": "Finalized/Revised - Adjudication information has been changed",
                "statusCode": "101",
                "statusCodeValue": "Claim was processed as adjustment to previous claim.",
                "entityCode": "1E",
                "entity": "Health Maintenance Organization (HMO)",
                "effectiveDate": "20170412",
                "submittedAmount": "1229",
                "amountPaid": "184.05",
                "trackingNumber": "C1234567891028297LL",
                "claimServiceDate": "20160722",
                "tradingPartnerClaimNumber": "AAAAAAAAAAA2"
            }
        },
        {
            "claimStatus": {
                "statusCategoryCode": "F3",
                "statusCategoryCodeValue": "Finalized/Revised - Adjudication information has been changed",
                "statusCode": "101",
                "statusCodeValue": "Claim was processed as adjustment to previous claim.",
                "entityCode": "1E",
                "entity": "Health Maintenance Organization (HMO)",
                "effectiveDate": "20161201",
                "submittedAmount": "1229",
                "amountPaid": "219",
                "trackingNumber": "C1234567891028297LL",
                "claimServiceDate": "20160722",
                "tradingPartnerClaimNumber": "AAAAAAAAAAA3"
            }
        }
    ],
    "reassociationKey": "000000001",
    "status": "success"
    "meta": {
        "senderId": "Peter.Corazao",
        "traceId": "4e6b182a-63ef-2647-4214-7c50d9f20600",
        "applicationMode": "dev"
    }
}

Let's take a closer look at the components of the Claim Status 277 response, which is translated from EDI to JSON by the API.

Metadata (for Troubleshooting)

Change Healthcare Medical Network APIs support a significant troubleshooting feature called metadata. API users do not need to enable this capability; it is automatic and has no effect on information in any medical transaction. If you encounter any issues with a transaction and need to work with CHC technical support, give the values provided in the `meta` object to the CHC representative.
JSON Response Object Description
{
   "meta": {
       "senderId": "Xxxx.Xxxxxx",
       "traceId": "900773a9-c0ba-6aa2-0f61-cfcc30a0200f",
       "applicationMode": "prod"
   },










Give this entire object to CHC
support for troubleshooting. All values
listed in the meta object are automatically
taken from the API request header or
from the secure token.
The senderId is a unique value denoting
the API customer.
ApplicationMode describes the
operating environment, which for API
customers will either be
Production ("prod") or Sandbox.





Understanding Specific Attributes and Objects

Most Claim Status 277 responses will contain a header with several attributes. It includes the originating controlNumber under which the originating claim request was made; the tradingartnerServiceId Payer ID; and other payer identification.

The providers object lists each of the providers involved in the claim submission. This will include the billing provider.

The claimStatus object contains the key Claim Status content. As you can see above, you can have multiple instances of this object in a single claim. It consists of the following attributes:

Attribute NameValues
statusCategoryCodeCode value showing the status of the claim with a two-digit alphanumeric value. Characteristic values: F1 indicates the service line for the claim is paid; F3 indicates the claim is adjusted and final; A4 indicates that the specified claim service line does not exist in the payer system.
statusCategoryCodeValuePlain-language description of the status of the claim.
statusCodeThe Valid Claim Status code. Usually will show a value of 101, stating it's a valid claim.
statusCodeValueProvides more information about how the claim was processed.
entityCodeThe code identifying the entity type associated with the service line. 1E - HMO; 2P - Public Health Service Facility;
entityNon-code description of the entity type.
effectiveDateDate the claim line item was placed in its current status by the payer's adjudication process.
submittedAmountTotal amount billed for the service line.
amountPaidAmount the payer agreed to pay. The remainder from this will be the patient's responsibility.
paidDateDate of denial or approval of the claim service line.
checkIssueDate, checkNumberPaper check or EFT funds available date and trace number.
claimServiceDateDate or date range of the medical service. Format YYYYMMDD.
tradingPartnerClaimNumberThe payer's assigned control number.

You can look up the entire statusCategoryCode table and its associated statusCategoryCodeValue table in the X12 EDI standards page. Some coding information is accessible only through copyrighted subscription and hence can't be fully described here.


Did this page help you?