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EDI 275 Format Example

EDI 275 Patient Information

What is EDI 275 A2 Patient Information?

The EDI 275 A2 transaction set is used to communicate individual patient information requests and patient information between separate healthcare entities in a variety of settings to be consistent with confidentiality and use requirements. Patient information consists of demographic, clinical, and other supporting data. The EDI 275 can be sent either solicited or unsolicited. The EDI 275 Patient Information is an EDI transaction designed to carry attachments.

In the Health Insurance Portability and Accountability Act (HIPAA), the term “attachment” refers to the exchange of patient specific medical information or supplemental documentation to support an administrative healthcare transaction. 

Claim attachments, in the context of healthcare EDI, are supplemental electronic documents that provide additional medical information that cannot be accommodated within the claim format. Such as:

  • EEG
  • EKG
  • X-ray image
  • Lab report
  • Health Level 7 (HL7) report
  • Demographic, clinical and other supporting data in an electronic representation that can be attached as payload.

HL7 C-CDA allows for unstructured documents including: 

  • MS WORD 
  • PDF 
  • Plain Text 
  • RTF Text 
  • HTML Text 
  • GIF Image 
  • TIF Image 
  • JPEG Image 
  • PNG Image 

The 275 transaction functionality includes both:

  • Solicited Attachments: Documentation submitted in response to a specific request.
  • Unsolicited Attachments: Documentation known to be needed and submitted at the same time as the claim.

The X12 EDI transaction sets employed in requesting and/or receiving 275 attachments include:

Healthcare Claim Additional Information

EDI 277 Healthcare Claim Request for Additional Information
EDI 275 Additional Information to Support a Healthcare Claim or Encounter

Healthcare Services Review Request

EDI 278 Healthcare Services Review – Request for Review
EDI 278 Healthcare Services Review – Response
EDI 275 Additional Information to Support a Healthcare Services Review

Healthcare Claim and Encounter plus Additional Supporting Information
Provider initiated coordination of benefits:
EDI 837 Healthcare Claim: Professional
EDI 837 Healthcare Claim: Dental
EDI 837 Healthcare Claim: Institutional
EDI 277 Healthcare Claim Acknowledgment
EDI 275 Additional Information to Support a Healthcare Claim or Encounter

X12, chartered by the American National Standards Institute for more than 35 years, develops and maintains EDI standards and XML schemas.

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