999 and 277CA Response Reports


A 999 Fuctional Acknowledgement or 277CA response may be produced from claim files submitted in the X12 version 5010 format. The 999 Transaction and 277CA Claims Acknowledgement reports inclues examples of these reports:

  • Example 1 – 999 Functional Acknowledgement showing an 837 was received with no errors
  • Example 2 – 277CA showing electronically submitted claims with no errors
  • Example 3 – 277CA showing electronically submitted claims with errors

Disclaimer: These reports are examples only and are subject to change.

If you have any questions regarding this information, please contact the Palmetto GBA Provider Contact Center at 855-696-0705 (JM), 888-355-9165 (RR) or 877-567-7271 (JJ).





Last Updated: 03/24/2021