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EDI Claim Status Request management

Updated on April 12, 2021
Pega Foundation for Healthcare Product Overview

Pega Foundation for Healthcare provides a reference implementation to manage X12 5010 EDI straight-through processing for X12 276 and 277 message transactions – Healthcare Claim Status Request & Response. This capability includes the ability to intake the EDI X12 276 claims status inquiry request message, parse the message according to the EDI transaction implementation guide, create a case, process the claim status request (leveraging the sample claims provided in the sample data layer), and return an appropriate X12 277 claim status response message. The functionality can be extended based on your business rules and with appropriate integration with your claims system.

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