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Solicited claims status request/response (276/277)

Suggest edit Updated on April 26, 2021

Pega Smart Claims Engine for Healthcare can receive and process a Claim Status Request file (276) and generate a Claims Status Response (277). The Status Request transaction to be imported must be clean and formatted. It must also be complete and well-formed XML that conforms to the ACS X12 XML format.

Requests to be imported can be dropped into a specified file location at any time of the day. A file listener recognizes the arrival of the file, reads it, and processes it in real time.

The CE276FileListener rule listens for a defined file at a specific file location in the server directory. The rule, by default, listens for the XML276.xml file at the Source location \XMLOut\276In. Change these settings to match your requirements.

At a minimum:

  1. Create a directory structure where you can drop your 276 Claim Status Requests. Enter that location in the Source location field.
  2. Modify the value in the Source Name Mask field to a value that identifies your 276 XML files.

    This setting is typically set to a mask, for example, *.xml.

  3. Modify the output file name as specified in Step 10 of the Activity: ClaimStatusRequest screen (shown below) to a unique name.

  4. The request is processed by the CEXML276RequestFileService service method. It parses the request and performs a search for the claims that meet the parameters of the request.
  5. The ClaimStatusRequest activity compiles the search results and creates the Response (277) in the file location specified in the Destination path field of the connect rule.

The Response is now ready for selection. It is returned to the requesting system.

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