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The Claims Status API supports the X12 EDI 276 transaction. It translates this standard to JSON for developer accessibility and integration into users’ applications.

The submitter uses a Claim Status request to ask about the status of a previously submitted claim. The payer returns the response, as an X12 EDI 277 transaction, which is translated back to JSON by the API gateway. It describes where the claim is in the adjudication process (for example, Pending or Finalized).

If the claim is finalized, the response provides the disposition of the claim (for example, Paid, or Denied). For denied or rejected outcomes, the response includes the reasons for the denial or rejection.

We also support a dedicated Raw X12 Claims Status API to format your submission in X12 EDI format. It supports the standard syntax for a complete X12 EDI 276 transaction set.