Example 4: Information Receiver Level Status

Business Scenario Description:
This scenario depicts an Information Receiver level status in the 277 Response due to the Payer’s system not being available.

Business Scenario Explanation:
XYZ Service, a Clearinghouse, has an electronic transmitter identification number of X67E (Loop 2100B NM109) which it uses to conduct electronic business transactions with ABC Insurance. ABC Insurance has a payer identification of 12345 (Loop 2100A NM109). XYZ Service assigned their own unique Claim Identifier for Transmission Intermediaries number of XYZSMITH123 for tracking purposes (Loop 2200D REF01 = D9).

Home Hospital uses XYZ Service to submit claim status requests to ABC Insurance. Home Hospital's National Provider Identifier (NPI) is 1666666661 (Loop 2100C NM109).

Fred Smith is the subscriber with a member identification number of 123456789 (Loop 2100D NM109). Fred Smith's birth date is 12/10/1980 (Loop 2000D DMG02). A Claim Status Trace Number of ABCXYZ1 (Loop 2200D TRN02) was assigned to the status request for Fred Smith's claim. Home Hospital requested the status of a claim for inpatient services (Type of Bill 111, Loop 2200D REF01=BLT) for services August 31, 2025 through September 6, 2025 (Loop 2200D DTP01=472) in the amount of $8,513.88 (Loop 2200D AMT01=T3). Home Hospital provided a Provider’s Assigned Claim Identifier of SM123456 (Loop 2200D REF01=X1).

ABC Insurance was unable to respond to the specific claim status request due to system availability. ABC Insurance responded at the Information Receiver Level indicating a response was not possible (Loop 2200B STC01-01= E1- Response not possible - System Status) because the system was currently unavailable (Loop 2200B STC01-02= 484- Business Application Currently Not Available) and identified the entity as the payer (Loop 2200B STC01-03= PR – Payer).