275 Claim Attachment Transactions via EDI
Electronic Attachments (275 transactions) are supplemental documents providing additional patient medical information to the payer that cannot be accommodated within the ANSI ASC X12, 837 claim format. Common attachments are certificates of medical necessity (CMNs), discharge summaries, and operative reports to support a healthcare claim adjudication.
There are two cases of EDI 275 as follows:
1) Solicited 275 Transaction: Provider receives a 277R response from the payer, requesting additional information. Provider submits a 275.
2) Unsolicited 275 Transaction: Provider submits supplemental information on a pre-adjudicated claim submission that is not required on the actual submission but will
Assist the payer in determining accurate benefits during the adjudication process.
When to Submit ?
The payer requests supporting documentation for a claim.
The provider proactively sends additional clinical data to support a claim (EDI 837P/ EDI 837I /r EDI 837D) or authorization.
How to attach document in EDI 275 Message ?
All attachment information must be MIME-packaged
A sample MIME encoded attachment format:
MIME-Version: 1.0
Content-Type: image/tiff
Content-Transfer-Encoding: base64
Content-Disposition: attachment; filename="patientxray.tif"
<Base64 encoded data>
Mime-Version: 1.0
Content-Type: application/pdf
Content-Transfer-Encoding: base64
Content-Disposition: attachment; filename=GS.TSOF36E.275AT20180501452_001_1525194905295_189410.pdf
<BASE64 STRING>~
To create the attachment file for the 275 messages, we first need to convert the file to Base64 encoding characters.
The following file types are supported:
• Acrobat (pdf)
• Bitmap (bmp)
• Graphic interchange format (gif)
• JPEG image (jpg)
• Portable network graphics (png)
• Tagged Image File (tif)
• XML text (ex: CDA)
How the payer will process our Unsolicited 275 Transaction
Sample EDI 275 Claim Attachment
ISA*00* *00* *ZZ*111134 *01*zirmed *200219*0749*^*00501*796000000*0*P*:
GS*PI*111134*zirmed*20200219*0749*796*X*005010X210
ST*275*1234*005010X210
BGN*02*1000*20180514
NM1*PR*2*XYZ Insurance*****PI*21231
NM1*41*2*Demo Practice*****46*111134
NM1*1P*1*JOHN*MUFFY*M**M.D*XX*123456789
NX1*1P
N3*PO BOX 123*157 WEST 57TH STREET
N4*CINCINNATI*OH*43017
NM1*QC*1*CARROL*JENNIFER*T**PH.D*MI*9012345918341
REF*EJ*1231232
REF*EA*9999999
REF*D9*1212323
LX*1
TRN*1*123123
DTP*368*D8*20180514
CAT*AE*MB
EFI*05
BIN*1097*Mime-version: 1.0
Content-Type: application/pdf
Content-Transfer-Encoding: base64
Content-Disposition: attachment; filename=right_arm-pictures.pdf
JVBERi0xLjcKCjQgMCBvYmoKPDwKL0JpdHNQZXJDb21wb25lbnQgOAovQ29sb3JTcGFjZSAvRGV2aWNlUkdCCi9GaWx0ZXIgL0RDVERlY29kZQovSGVpZ2h0IDE3OAovTGVuZ3RoIDkzNDIKL1N1YnR5cGUgL0ltYWdlCi9UeXBlIC9YT2JqZWN0Ci9XaWR0aCA0ODkKPj4Kc3RyZWFtCv/Y/+AAEEpGSUYA
SE*19*1234
GE*1*796
IEA*1*796000000
One claim with two attachments example
ISA*00* *00* *ZZ*111134 *01*zirmed *200219*0749*^*00501*796000000*0*P*:
GS*PI*111134*zirmed*20200219*0749*796*X*005010X210
ST*275*5312*005010X210
BGN*02*1000*20180514
NM1*PR*2*XYZ Insurance*****PI*21231
NM1*41*2*Demo Practice*****46*111134
NM1*1P*1*JOHN*MUFFY*M**M.D*XX*123456789
NX1*1P
N3*PO BOX 123*157 WEST 57TH STREET
N4*CINCINNATI*OH*43017
NM1*QC*1*CARROL*JENNIFER*T**PH.D*MI*9012345918341
REF*EJ*1231232
REF*EA*9999999
REF*D9*1212323
LX*1
TRN*1*123123
DTP*368*D8*20180514
CAT*AE*MB
EFI*05
BIN*1097*Mime-version: 1.0
Content-Type: application/pdf
Content-Transfer-Encoding: base64
Content-Disposition: attachment; filename=right_arm-pictures.pdf
JVBERi0xLjcKCjQgMCBvYmoKPDwKL0JpdHNQZXJDb21wb25lbnQgOAovQ29sb3JTcGFjZSAvRGV2aWNlUkdCCi9GaWx0ZXIgL0RDVERlY29kZQovSGVpZ2h0IDE3OAovTGVuZ3RoIDkzNDIKL1N1YnR5cGUgL0ltYWdlCi9UeXBlIC9YT2JqZWN0Ci9XaWR0aCA0ODkKPj4Kc3RyZWFtCv/Y/+AAEEpGSUYA
LX*2
TRN*1*52412
DTP*368*D8*20180514
CAT*AE*MB
EFI*05
BIN*2097*Mime-version: 1.0
Content-Type: application/pdf
Content-Transfer-Encoding: base64
Content-Disposition: attachment; filename=left_arm-pictures.pdf
JVBERi0xLjcKCjQgMCBvYmoKPDwKL0JpdHNQZXJDb21wb25lbnQgOAovQ29sb3JTcGFjZSAvRGV2aWNlUkdCCi9GaWx0ZXIgL0RDVERlY29kZQovSGVpZ2h0IDE3OAovTGVuZ3RoIDkzNDIKL1N1YnR5cGUgL0ltYWdlCi9UeXBlIC9YT2JqZWN0Ci9XaWR0aCA0ODkKPj4Kc3RyZWFtCv/Y/+AAEEpGSUYA
SE*25*5312
GE*1*796
IEA*1*796000000
JSON to EDI 275 Message
Looking for JSON to EDI solution ?
Looking for more examples ? Login into our EDI Tool
https://demo.nagatabilling.com/NagataEDITool/login.zhtml