EDI 277CA Claim Acknowledgment — Data Dictionary

This page explains the 174 columns in the current supported Smart Mapping projection for X12 EDI 277CA files.

Use it to understand claim and service-line acknowledgment status, submitter and provider context, STC status codes, and reported errors.

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CSV/Excel mapping of the 174 current Smart Mapping columns and their EDI 277CA sources. No PHI.

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Current Smart Mapping contract

Routing. Smart Mapping supports a 277 transaction when ST03 is exactly 005010X214, or when ST03 is blank and GS08 is exactly 005010X214. Near matches and other implementations are Raw-only.

Ownership and grain. HL02 is authoritative for source, receiver, provider, and claim ownership, including a valid non-current parent. Missing, unresolved, duplicate, self-referential, or otherwise malformed parents fail closed. Primary NM101 roles are PR = information source, 41 = information receiver, 85 = billing provider, and QC = patient; a wrong-role NM1 does not replace the primary context. A primary Smart row represents one STC occurrence at receiver, provider, claim, or service-line scope. Meaningful claim or service contexts may produce a fallback row when no STC exists.

Status and identifiers. Claim-level 2200D STC and service-line 2220D STC remain distinct. STC01 supplies category, claim-status, entity, and represented qualifier components; STC02 is the effective date; STC03 the action; STC04/STC05 amounts; STC06 paid date; STC07 payment method; STC08 check date; STC09 check/EFT reference; STC10/STC11 additional composites; and STC12 the message. Composite parsing follows the interchange's ISA16 separator. Claim identifiers are qualifier-specific: TRN02 = submitter claim identifier, REF1K = payer claim control, and REFD9 = intermediary control; a generic first REF does not fill a named identifier.

References and dates. Claim REF and DTP472 evidence stays claim-owned. Service References, Service Date Format, and Service Date are service-owned and never promote into claim fields or sibling services. D8 is one CCYYMMDD date; RD8 is a CCYYMMDD-CCYYMMDD range. The validator checks real dates and range order. ISA09 is YYMMDD, not CCYYMMDD.

Validation semantics. Provider-level TRN and STC are situational, not universally required. Service-level rejected issues use the allowed U action semantics and are service-line acknowledgments, not final payment denials. Signed decimals are preserved, and X12 real-number forms such as .1 and 1. are accepted where applicable. Source-reported QTY/AMT values remain distinct from detailed entity and STC occurrence counts.

Schema and privacy boundary. 277CA has one unified 174-field Smart Mapping schema and no separate Key schema. This is the current supported projection, not exhaustive X214 coverage and not a lossless hierarchical X12 export. Bounded or omitted areas include broader provider PRV/address/contact/secondary IDs, source/receiver REF breadth, receiver PER, richer patient demographics, broad code dictionaries and provider identifiers, and public fields for non-472 service DTP. With De-identify PHI enabled, protected Smart values flow through rows, Summary, validation presentation, CSV, JSON, XLSX, and XML. Raw segments preserves original segment rows, does not use the 174-field projection, and is not de-identified.

Column Definitions

Applies to the Client-Side EDI 277CA claim-acknowledgment layout
ColumnEDI SourceDescription
File Name N/A (converter) Name of the input 277CA EDI file. Useful when processing acknowledgments from multiple files.
ID N/A (converter) Converter-generated stable row identifier for this mapped row. It is not source-supplied and does not expose private occurrence internals.
Transaction Type ST01 / ST03 (normalized) Normalized transaction type. Use 277CA when ST01 is 277 and the implementation reference identifies 005010X214.
Record Type N/A (converter; derived from 2200B/2200C/2200D/2220D) Identifies the output row as Transaction Status, Provider Status, Claim Status, or Service Line Status.
Status Number N/A (converter) Sequential status occurrence number within the applicable transaction, provider, claim, or service-line context.
Status Level N/A (converter; derived from loop) Human-readable status level: Information Receiver, Billing Provider, Claim, or Service Line.
Status Source Loop 2200B / 2200C / 2200D / 2220D X12 loop containing the STC segment represented by this row.
Acceptance Result STC03 (normalized) Human-readable result derived from the current STC action code, normally Accepted for WQ or Rejected for U.
Status Summary STC01/STC10/STC11/STC12 (derived) Concise human-readable summary generated from the current status category, claim status code, entity, additional status composites, and free-form message.
Current Hierarchical ID HL01 Hierarchical ID number for the HL loop associated with this status row. Service-line rows inherit the patient-level HL because 2220D does not begin with a separate HL.
Parent Hierarchical ID HL02 Hierarchical ID number of the parent HL loop for the current status context.
Hierarchical Level Code HL03 Code identifying the current hierarchy level, such as information receiver, billing provider, or patient.
Hierarchical Child Code HL04 Indicates whether additional subordinate HL loops follow beneath the current hierarchy level.
Primary Status Category Code STC01-1 Primary Health Care Claim Status Category Code. In 277CA batch acknowledgments, X214 uses acknowledgment category codes beginning with A; real-time responses may also use limited E-category codes.
Primary Status Category Description STC01-1 code translation Human-readable description of the Primary Status Category Code from the X12 Claim Status Category Code list.
Primary Claim Status Code STC01-2 Primary Health Care Claim Status Code identifying the specific acceptance or rejection condition.
Primary Claim Status Description STC01-2 code translation Human-readable description of the Primary Claim Status Code from the X12 Claim Status Code list.
Primary Status Entity Code STC01-3 Entity Identifier Code identifying the entity associated with the primary status, when supplied.
Primary Status Entity Description STC01-3 code translation Human-readable description of the entity associated with the primary status.
Primary Status Code List Qualifier STC01-4 Code List Qualifier identifying an alternate code source for STC01-2 when supplied.
Additional Status 1 Category Code STC10-1 Additional Health Care Claim Status Category Code used to further explain the current status.
Additional Status 1 Category Description STC10-1 code translation Human-readable description of Additional Status 1 Category Code.
Additional Status 1 Claim Status Code STC10-2 Additional Health Care Claim Status Code providing another acceptance or rejection reason.
Additional Status 1 Claim Status Description STC10-2 code translation Human-readable description of Additional Status 1 Claim Status Code.
Additional Status 1 Entity Code STC10-3 Entity Identifier Code associated with the first additional status composite, when supplied.
Additional Status 1 Entity Description STC10-3 code translation Human-readable description of the entity associated with Additional Status 1.
Additional Status 1 Code List Qualifier STC10-4 Code List Qualifier identifying an alternate code source for STC10-2 when supplied.
Additional Status 2 Category Code STC11-1 Second additional Health Care Claim Status Category Code used to further explain the current status.
Additional Status 2 Category Description STC11-1 code translation Human-readable description of Additional Status 2 Category Code.
Additional Status 2 Claim Status Code STC11-2 Second additional Health Care Claim Status Code providing another acceptance or rejection reason.
Additional Status 2 Claim Status Description STC11-2 code translation Human-readable description of Additional Status 2 Claim Status Code.
Additional Status 2 Entity Code STC11-3 Entity Identifier Code associated with the second additional status composite, when supplied.
Additional Status 2 Entity Description STC11-3 code translation Human-readable description of the entity associated with Additional Status 2.
Additional Status 2 Code List Qualifier STC11-4 Code List Qualifier identifying an alternate code source for STC11-2 when supplied.
Status Effective Date STC02 Date the reported status became effective.
Action Code STC03 Raw action code for the current status. In 277CA this is normally WQ for Accept or U for Reject; service-line status permits rejection only.
Action Description STC03 code translation Human-readable description of the action code.
Submitted Charge Amount STC04 Submitted charge amount represented by the current status level: the 837 total at 2200B, provider total at 2200C, claim charge at 2200D, or service amount when used at 2220D.
Paid Amount STC05 Amount paid when supplied in the status segment. This is normally unused in a pre-adjudication 277CA but is retained when present.
Paid Date STC06 Paid or finalized date supplied in the status segment when present.
Payment Method Code STC07 Payment method code supplied in the status segment when present.
Payment Method Description STC07 code translation Human-readable description of the payment method code.
Check Issue Date STC08 Check or payment issue date supplied in the status segment when present.
Check/EFT Number STC09 Check or electronic payment reference number supplied in the status segment when present.
Status Message STC12 Free-form status information supplied by the sender.
277CA Transaction Control Number ST02 Transaction set control number assigned to the 277CA transaction.
277CA Implementation Reference ST03 Implementation convention reference for the claim acknowledgment. Expected to be 005010X214.
Hierarchical Structure Code BHT01 Code identifying the hierarchical structure used by the 277CA transaction. X214 commonly uses 0085.
Transaction Set Purpose Code BHT02 Business purpose of the 277CA transaction. X214 payer responses commonly use code 08.
277CA Application Transaction Identifier BHT03 Identifier assigned by the 277CA originator to this acknowledgment transaction.
277CA Creation Date BHT04 Date the 277CA transaction was created in the sender's business application.
277CA Creation Time BHT05 Time the 277CA transaction was created in the sender's business application.
277CA Transaction Type Code BHT06 Transaction type code identifying the kind of hierarchical transaction, commonly TH in X214 examples.
Transmission Trace Type Code 2200A TRN01 Trace type code used for the transmission receipt control identifier.
Transmission Receipt Control Number 2200A TRN02 Control identifier assigned to the received claim transmission by the information source.
Transmission Originating Company Identifier 2200A TRN03 Originating company identifier from the transmission-level trace segment, when supplied.
Transmission Reference Identifier 2200A TRN04 Additional transmission-level trace reference, when supplied.
Original 837 Receipt Date Format 2200A DTP02 where DTP01=050 Date format qualifier for the date the original claim transmission was received.
Original 837 Receipt Date 2200A DTP03 where DTP01=050 Date the original 837 claim transmission was received by the information source.
Acknowledgment Process Date Format 2200A DTP02 where DTP01=009 Date format qualifier for the acknowledgment processing date.
Acknowledgment Process Date 2200A DTP03 where DTP01=009 Date the claim transmission was processed for acknowledgment.
Information Source Entity Type 2100A NM102 Entity type qualifier for the information source, usually an organization.
Information Source Name 2100A NM103 Organization or last name of the payer or other information source sending the 277CA.
Information Source First Name 2100A NM104 First name of the information source when the entity is an individual.
Information Source Middle Name 2100A NM105 Middle name or initial of the information source when supplied.
Information Source Name Prefix 2100A NM106 Name prefix of the information source when supplied.
Information Source Name Suffix 2100A NM107 Name suffix of the information source when supplied.
Information Source ID Qualifier 2100A NM108 Qualifier identifying the type of information source identifier in NM109, commonly PI for payer identification.
Information Source ID 2100A NM109 Identifier of the payer or information source.
Information Source Contact Function Code 2100A PER01 Code identifying the function of the information source contact.
Information Source Contact Name 2100A PER02 Name of the information source contact when supplied.
Information Source Contact Details 2100A PER03-PER08 (normalized) All communication qualifier and number pairs from the information source contact segment, preserved in source order as readable qualifier:value entries.
Information Receiver Entity Type 2100B NM102 Entity type qualifier for the information receiver or submitter.
Information Receiver Name 2100B NM103 Organization or last name of the information receiver.
Information Receiver First Name 2100B NM104 First name of the information receiver when supplied.
Information Receiver Middle Name 2100B NM105 Middle name or initial of the information receiver when supplied.
Information Receiver Name Prefix 2100B NM106 Name prefix of the information receiver when supplied.
Information Receiver Name Suffix 2100B NM107 Name suffix of the information receiver when supplied.
Information Receiver ID Qualifier 2100B NM108 Qualifier identifying the type of information receiver identifier in NM109, commonly 46 for an electronic transmitter identifier.
Information Receiver ID 2100B NM109 Identifier of the information receiver or claim submitter.
Original 837 Trace Type Code 2200B TRN01 Trace type code used for the information receiver application trace.
Original 837 Transaction Identifier 2200B TRN02 Information-receiver-owned TRN02 occurrence values in physical source order; repeated identical occurrences remain repeated.
Original 837 Originating Company Identifier 2200B TRN03 Originating company identifier from the 837 transaction trace, when supplied.
Original 837 Reference Identifier 2200B TRN04 Additional trace reference for the original 837 transaction, when supplied.
Transaction Acceptance Result 2200B STC03 (normalized) Overall result for the entire original 837 ST/SE transaction: Accepted or Rejected.
Transaction Submitted Charge Total 2200B STC04 Sum of submitted claim charges represented by the single original 837 ST/SE transaction being acknowledged.
Transaction Accepted Claim Count 2200B QTY02 where QTY01=90 Source-reported accepted-claim quantity occurrence values in physical source order; this is not a detailed-row-derived count.
Transaction Rejected Claim Count 2200B QTY02 where QTY01=AA Source-reported rejected-claim quantity occurrence values in physical source order; this is not a detailed-row-derived count.
Transaction Accepted Claim Amount 2200B AMT02 where AMT01=YU Source-reported accepted-claim amount occurrence values in physical source order; repeated values are not summed by this field.
Transaction Rejected Claim Amount 2200B AMT02 where AMT01=YY Source-reported rejected-claim amount occurrence values in physical source order; repeated values are not summed by this field.
Other Transaction Quantities Other 2200B QTY segments Other transaction-level qualifier:value occurrences in physical source order; repeated identical occurrences remain repeated.
Other Transaction Amounts Other 2200B AMT segments Other transaction-level qualifier:value occurrences in physical source order; repeated identical occurrences remain repeated.
Billing Provider Entity Type 2100C NM102 Entity type qualifier for the billing provider.
Billing Provider Name 2100C NM103 Organization or last name of the billing provider.
Billing Provider First Name 2100C NM104 First name of the billing provider when the entity is an individual.
Billing Provider Middle Name 2100C NM105 Middle name or initial of the billing provider when supplied.
Billing Provider Name Prefix 2100C NM106 Name prefix of the billing provider when supplied.
Billing Provider Name Suffix 2100C NM107 Name suffix of the billing provider when supplied.
Billing Provider ID Qualifier 2100C NM108 Qualifier identifying the billing provider identifier in NM109, such as XX for NPI or FI for tax identification.
Billing Provider ID 2100C NM109 Billing provider identifier associated with the qualifier in NM108.
Billing Provider NPI 2100C NM109 where NM108=XX (derived) Billing provider National Provider Identifier when NM108 identifies the value as an NPI.
Billing Provider Tax ID 2100C NM109 where NM108=FI (derived) Billing provider federal tax identifier when NM108 identifies the value as a tax ID.
Provider Trace Type Code 2200C TRN01 Trace type code used for the provider-of-service information trace.
Provider Trace Number 2200C TRN02 Provider-owned TRN02 occurrence values in physical source order; provider TRN is situational and repeated identical occurrences remain repeated.
Provider Originating Company Identifier 2200C TRN03 Originating company identifier from the provider-level trace segment, when supplied.
Provider Reference Identifier 2200C TRN04 Additional provider-level trace reference, when supplied.
Provider Acceptance Result 2200C STC03 (normalized) Overall result for the billing provider's group of claims: Accepted or Rejected.
Provider Submitted Charge Total 2200C STC04 Sum of submitted claim charges for the billing provider's group of claims in the acknowledged 837 transaction.
Provider Accepted Claim Count 2200C QTY02 where QTY01=QA Source-reported provider accepted-claim quantity occurrence values in physical source order.
Provider Rejected Claim Count 2200C QTY02 where QTY01=QC Source-reported provider rejected-claim quantity occurrence values in physical source order.
Provider Accepted Claim Amount 2200C AMT02 where AMT01=YU Source-reported provider accepted-claim amount occurrence values in physical source order; not a derived total.
Provider Rejected Claim Amount 2200C AMT02 where AMT01=YY Source-reported provider rejected-claim amount occurrence values in physical source order; not a derived total.
Other Provider Quantities Other 2200C QTY segments Other provider-level qualifier:value occurrences in physical source order; repeated identical occurrences remain repeated.
Other Provider Amounts Other 2200C AMT segments Other provider-level qualifier:value occurrences in physical source order; repeated identical occurrences remain repeated.
Patient Entity Type 2100D NM102 Entity type qualifier for the patient.
Patient Last Name 2100D NM103 Patient last name or organization name returned from the original claim.
Patient First Name 2100D NM104 Patient first name.
Patient Middle Name 2100D NM105 Patient middle name or initial when supplied.
Patient Name Prefix 2100D NM106 Patient name prefix when supplied.
Patient Name Suffix 2100D NM107 Patient name suffix when supplied.
Patient ID Qualifier 2100D NM108 Qualifier identifying the patient or member identifier in NM109, commonly MI.
Patient Member ID 2100D NM109 Patient or member identifier returned in the 277CA.
Claim Trace Type Code 2200D TRN01 Trace type code used for the claim status tracking number.
Claim Submitter Identifier 2200D TRN02 Claim-owned TRN02 occurrence values corresponding to submitter claim identifiers in physical source order; repeated identical occurrences remain repeated.
Claim Originating Company Identifier 2200D TRN03 Originating company identifier from the claim-level trace segment, when supplied.
Claim Reference Identifier 2200D TRN04 Additional claim-level trace reference, when supplied.
Claim Acceptance Result 2200D STC03 (normalized) Claim-level preprocessing acknowledgment disposition; it is not final adjudication or payment status.
Claim Submitted Charge Amount 2200D STC04 Original submitted charge amount for the acknowledged claim.
Payer Claim Control Number 2200D REF02 where REF01=1K Claim-owned REF1K occurrence values in physical source order; generic REF values never populate this named field.
Claim Identifier for Transmission Intermediaries 2200D REF02 where REF01=D9 Claim-owned REFD9 occurrence values in physical source order; generic REF values never populate this named field.
Other Claim References Other 2200D REF segments Other claim-owned qualifier:value occurrences in physical source order; service REF evidence is excluded and repeated identical occurrences remain repeated.
Claim Service Date Format 2200D DTP02 where DTP01=472 Claim-owned DTP472 format occurrence values in physical source order; D8 is CCYYMMDD and RD8 is CCYYMMDD-CCYYMMDD.
Claim Service Date 2200D DTP03 where DTP01=472 Claim-owned DTP472 date or range occurrence values in physical source order; service DTP values are excluded.
Service References 2220D REF01/REF02 Service-owned qualifier:value occurrences in physical source order; claim and sibling-service references are excluded and repeated identical occurrences remain repeated.
Service Date Format 2220D DTP02 where DTP01=472 Service-owned DTP472 format occurrence values in physical source order; blank on non-service rows and non-472 service DTP is outside this public field.
Service Date 2220D DTP03 where DTP01=472 Service-owned DTP472 date or range occurrence values in physical source order; claim and sibling-service dates are excluded and repeated identical occurrences remain repeated.
Service Line Number N/A (converter; derived from 2220D occurrence) Sequential service-line acknowledgment number within the claim.
Service Product/Service ID Qualifier 2220D SVC01-1 Qualifier identifying the code system used for the submitted procedure or service code.
Service Procedure Code 2220D SVC01-2 Submitted procedure or service code associated with the rejected service line.
Service Procedure Modifier 1 2220D SVC01-3 First procedure modifier associated with the submitted service.
Service Procedure Modifier 2 2220D SVC01-4 Second procedure modifier associated with the submitted service.
Service Procedure Modifier 3 2220D SVC01-5 Third procedure modifier associated with the submitted service.
Service Procedure Modifier 4 2220D SVC01-6 Fourth procedure modifier associated with the submitted service.
Service Procedure Description 2220D SVC01-7 Free-form description associated with the submitted procedure or service code when supplied.
Service Procedure Code Range End 2220D SVC01-8 Ending procedure or service code when the SVC01 composite identifies a code range.
Service Submitted Charge Amount 2220D SVC02 Original submitted charge amount for the service line.
Service Paid Amount 2220D SVC03 Amount paid for the service line when supplied. Normally unused for a pre-adjudication 277CA rejection.
Service Revenue Code 2220D SVC04 National Uniform Billing Committee revenue code associated with the service line when supplied.
Service Paid Units 2220D SVC05 Paid units of service when supplied.
Original Service ID Qualifier 2220D SVC06-1 Qualifier identifying the code system used for the original procedure or service code when an alternate code is returned.
Original Service Procedure Code 2220D SVC06-2 Original submitted procedure or service code when an alternate or corrected service code is returned.
Original Service Modifier 1 2220D SVC06-3 First modifier associated with the original service code.
Original Service Modifier 2 2220D SVC06-4 Second modifier associated with the original service code.
Original Service Modifier 3 2220D SVC06-5 Third modifier associated with the original service code.
Original Service Modifier 4 2220D SVC06-6 Fourth modifier associated with the original service code.
Original Service Description 2220D SVC06-7 Free-form description associated with the original service code when supplied.
Original Service Code Range End 2220D SVC06-8 Ending original service code when the SVC06 composite identifies a code range.
Original Submitted Units 2220D SVC07 Original submitted units of service.
Service Line Acceptance Result 2220D STC03 (normalized) Service-line result. X214 service-line detail is used only for a rejected service line that caused the claim rejection.
Functional Identifier Code GS01 Functional identifier code for the group containing the 277CA, commonly HN for Health Care Information Status Notification.
Functional Group Sender Code GS02 Application sender code for the functional group containing the 277CA.
Functional Group Receiver Code GS03 Application receiver code for the functional group containing the 277CA.
Functional Group Creation Date GS04 Date the functional group containing the 277CA was created.
Functional Group Creation Time GS05 Time the functional group containing the 277CA was created.
277CA Group Control Number GS06 Functional-group control number of the group containing the 277CA.
277CA Group Version GS08 Version, release, and implementation-guide identifier of the functional group containing the 277CA.
Interchange Sender Qualifier ISA05 Qualifier identifying the type of interchange sender identifier used in ISA06.
Interchange Sender ID ISA06 Interchange sender identifier. Fixed-width padding should be trimmed for display and export.
Interchange Receiver Qualifier ISA07 Qualifier identifying the type of interchange receiver identifier used in ISA08.
Interchange Receiver ID ISA08 Interchange receiver identifier. Fixed-width padding should be trimmed for display and export.
Interchange Date ISA09 Interchange creation date in X12 YYMMDD format; this is not a CCYYMMDD field.
Interchange Time ISA10 Time the interchange containing the 277CA was created.
Interchange Control Number ISA13 Interchange control number assigned to the interchange containing the 277CA.
Interchange Usage Indicator ISA15 Indicates whether the interchange is production, test, or information.

Notes

  • A 277CA reports preprocessing acknowledgment status at transaction, provider, claim, and supported service-line scopes; it is not a final adjudication or payment response.
  • STC segments communicate acknowledgment status and, when applicable, the category, status, and entity associated with a reported issue.
  • Some columns are normalized or generated by the converter for easier review. Source EDI codes remain the authoritative acknowledgment details.
Parse an EDI 277CA into structured fields.
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