[ X12 Examples ]
Com1 Software 277 Claim Status Response Example
Posted: Sunday, January 07 201811:35:23 AM
Com1 Software, Inc.
P.O. Box 482
Hudson, Ohio 44236
(330) 653-3771
information@com1software.com
Web Site :
[ com1software.com ]
Support :
[support.com1software.com]
X12 Examples :
[x12examples.com1software.com]
277 Claim Status Response Example
277 Claim Status Response source file.
ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *080319*2327*U*00501*002721171*0*P*:~ GS*HC*SENDER*RECEIVER*20080319*2327*27211711*X*005010X214~ ST*277*0001~ BHT*0010*08*277X093*19961120**DG~ HL*1*20*1~ NM1*PR*2*ABC INSURANCE*****PI*12345~ HL*2*1*21*1~ NM1*41*2*XYZ SERVICE*****46*X67E~ HL*3*2*19*1~ NM1*1P*2*HOME HOSPITAL*****SV*987666~ HL*4*3*22*0~ DMG*D8*19201210*M~ NM1*QC*1*SMITH*FRED****MI*123456789A~ TRN*2*1625032606~ STC*P3:60*19960930**8513.88*0~ REF*1K*96347006051~ REF*BLT*111~ REF*EA*11111111~ DTP*232*RD8*19960831-19960906~ SVC*HC:99214*75*50****1~ SVC*NU:71X*50*0****1~ HL*5*3*22*0~ DMG*D8*19201115*F~ NM1*QC*1*JONES*MARY****MI*234567890A~ TRN*2*1622241518~ STC*F0:3*19960930**7599*7599~ REF*1K*9629675341~ REF*BLT*111~ DTP*232*RD8*19960731-19960809~ SVC*HC:99215*755*50****1~ SVC*NU:72X*80*0****1~ HL*6*2*19*1~ NM1*1P*2*THE HOSPITAL*****SV*124567890~ HL*7*6*22*1~ DMG*D8*19451101*M~ NM1*IL*1*CAN*JOHN****MI*345678901~ HL*8*7*23~ DMG*D8*19651101*M~ NM1*QC*1*CAN*JOE****MI*345678901-02~ TRN*1*16270853402~ STC*F2:88:QC*19960930**4899.5*0~ REF*1K*961681010827~ REF*BLT*131~ DTP*232*RD8*19960501-19960530~ SVC*HC:99214*175*150****1~ SVC*NU:73X*150*0****1~ SE*38*0001~ GE*1*27211711~ IEA*1*002721171~