277CA Claim Acknowledgment: How to Read and Fix Claim Rejections

A 277CA is the electronic claim acknowledgment a payer or clearinghouse sends after you submit claims. For each claim it says whether the claim was accepted into the payer’s system or rejected, and if rejected, why. Rejected claims never reach adjudication, so they must be corrected and resubmitted before the filing deadline.

999 vs. 277CA vs. 835

Transaction	What it tells you	When it arrives
999	Whether the claim file was built correctly (syntax)	Minutes to hours after submission
277CA	Whether each claim was accepted into the payer’s system or rejected	Usually within a day or two
835 (ERA)	How each accepted claim was paid, adjusted or denied	After adjudication

How to read the STC segment

Each claim’s status is in an STC segment. Its first element has up to three parts: a claim status category code, a claim status code, and an entity identifier code. For example, STC*A7:562:85 means: rejected for invalid information (A7), Entity’s National Provider Identifier (562), billing provider (85). Clearinghouse reports translate these codes into text, which is why the same rejection can look different from one report to the next.

Claim status category codes

Category	Meaning	What to do
A1	Received, not yet accepted for adjudication	Wait for a further status
A2	Accepted into the adjudication system	Nothing; watch for the 835
A3	Returned as unprocessable, not entered into the system	Correct and resubmit
A4	Claim not found	Confirm it was sent to the right payer
A6	Rejected for missing information	Add what the status code names and resubmit
A7	Rejected for invalid information	Correct what the status code names and resubmit
A8	Rejected for relational field in error	Fix the fields that conflict with each other

Category wording is summarized from the X12 Claim Status Category Codes list (opens in a new tab).

Common 277CA rejection codes

Status code	X12 description	Guide
33	Subscriber and subscriber id not found	Read the fix
562	Entity’s National Provider Identifier (NPI)	Read the fix
116	Claim submitted to incorrect payer	Read the fix
128	Entity’s tax id	Read the fix
145	Entity’s specialty/taxonomy code	Read the fix
496	Submitter not approved for electronic claim submissions on behalf of this entity	Read the fix

Codes 128, 145, 496 and 562 require an entity code that names the party with the problem; that is what the “Usage: This code requires use of an Entity Code” note means. See our entity code guide for what each entity code points to.

Rejection vs. denial

A rejection is reported on the 277CA before adjudication: the payer never processed the claim, so you correct it and send it as a new claim. A denial is reported on the 835 after adjudication: the payer processed the claim and decided not to pay, so you correct, appeal or write off. Our claim denial guide covers the 835 side.

A daily rejection workflow

1. Pull the 999 and 277CA reports every day.
2. Sort rejections by status code, because one setup error can reject dozens of claims.
3. Fix the source data, such as the patient record, provider file or payer ID, not only the claim.
4. Resubmit as a new claim and confirm an A2 acceptance on the next 277CA.
5. Track rejections by cause each month.

Keep timely filing in mind: in most cases a rejected claim does not count as received, so the deadline keeps running.

Related claim rejection guides

• Status 33: subscriber and subscriber ID not found
• Status 562: Entity’s National Provider Identifier (NPI)
• Status 116: claim submitted to incorrect payer
• Status 128: Entity’s tax ID
• Status 145: Entity’s specialty/taxonomy code
• Status 496: submitter not approved for electronic claims
• “This code requires use of an Entity Code”

Status code wording is quoted from the X12 Claim Status Codes list (opens in a new tab) at the time of writing. Clearinghouse reports may show the same codes with slightly different text.