Sample EDI 277 Data for the Health Care Information Status Notification Transaction Set


AgencySet IDFGTrans DescCommittee
ANSI277HNHealth Care Information Status Notification Insurance


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Research and Development:
Below is a sample EDI 277 transaction set. The Jobisez.com site has an online translation tool that converts the EDI 277 (Health Care Information Status Notification) document into a CSV file. You can also gain knowledge by researching all EDI Document Types. Jobisez LLC can also provide assistance if you need additional help.

Sample of an EDI 277 Transaction Set

Entire Segment
ST*277*0001*005010X212
BHT*0010*11*xxxxxxxxxxx*20111111*111111*xx
HL*1**20*1
NM1*PR*1*xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx*****xx*11111
PER*IC*xxxxxxxxxxxxxxxxxxxxxxx*xx*1111111111
HL*2*1*21*1
NM1*41*1*xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx*****11*xxxxxx
HL*3*2*19*1
NM1*1P*1*xxxxxxxxxxxxxxxxxxxx*****xx*1111111111
HL*4*3*22*0
NM1*IL*1*xxxxxx*xxxxxxxx****xx*xxxxxxxxxxxx
TRN*2*xxxxxxxxxxx
STC*F2:111*20111111**1111
REF*1K*xxxxxxxxxxxxxxxx
DTP*472*RD8*20111111-20111111
SVC*HC:11111*1111*1****1
STC*F2:111*20111111
DTP*472*RD8*20111111-20111111
HL*5*3*22*0
NM1*IL*1*xxxxxxx*xxxxxx****xx*xxxxxxxxxxxx
TRN*2*xxxxxxxxxxx
STC*E0:11*20111111**1
DTP*472*RD8*20111111-20111111
HL*6*2*19*1
NM1*1P*1*xxxxxxxxxxxxxxxxxxxx*****xx*1111111111
HL*7*6*22*1
NM1*IL*1*xxxxx*xxxx****xx*xxxxxxxxxxxx
HL*8*7*23
NM1*QC*1*xxxxx*xxxxx
TRN*2*xxxxxxxxxxx
STC*F2:111*20111111**1111
REF*1K*xxxxxxxxxxxxxxxx
REF*EJ*xxxxxxxxxxxxxxxxxxxxxxxx
DTP*472*RD8*20111111-20111111
SVC*HC:11111*1111*1****1
STC*F2:11*20111111
DTP*472*RD8*20111111-20111111
TRN*2*xxxxxxxxxxx
STC*F2:111*20111111**1111
REF*1K*xxxxxxxxxxxxxxxx
DTP*472*RD8*20111111-20111111
SVC*HC:11111*1111*1****1
STC*F2:11*20111111
DTP*472*RD8*20111111-20111111
TRN*2*xxxxxxxxxxx
STC*F2:111*20111111**1111
REF*1K*xxxxxxxxxxxxxxxx
DTP*472*RD8*20111111-20111111
SVC*HC:11111:11*1111*1****1
STC*F2:111:xx*20111111
DTP*472*RD8*20111111-20111111
SVC*HC:11111*1111*1****1
STC*F2:111*20111111
DTP*472*RD8*20111111-20111111
HL*9*6*22*0
NM1*IL*1*xxxxxx*xxxxxxx****xx*xxxxxxxxxxxxxx
TRN*2*xxxxxxxxxxx
STC*F2:111*20111111**1111
REF*1K*xxxxxxxxxxxxxxxx
DTP*472*RD8*20111111-20111111
SVC*HC:11111*1111*1****1
STC*F2:11:xx*20111111
DTP*472*RD8*20111111-20111111
HL*10*6*22*0
NM1*IL*1*xxxxx*xxxxx****xx*xxxxxxxxxxxx
TRN*2*xxxxxxxxxxx
STC*E0:11*20111111
DTP*472*RD8*20111111-20111111
SE*69*0001

Solutions:
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