EDI 275 Patient Information
What is the EDI 275 Patient Information Transaction Set?
The EDI 275 Patient Information transaction set contains the format and establishes the data contents for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate individual patient information requests and patient information between a variety of separate healthcare entities 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.
EDI 275 enables providers to send information as electronic attachments such as Word documents, PDF files, text files, image files, and CDA files. The 275 attachment transaction can be indexed through each claim’s identifier and made available to processors and auditors.
The 275 transaction functionality includes both:
- Unsolicited Attachments: Documentation known to be needed and submitted at the same time as the claim.
- Solicited Attachments: Documentation submitted in response to a specific request.
EDI 275 Claim Status Request in Data Mapper
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EDI 275 Workflow Example
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Health Care Claim and Encounter plus Additional Supporting Information
EDI 837 Health Care Claim
EDI 277 Health Care Claim Acknowledgment
EDI 275 Additional Information to Support a Health Care Claim or Encounter
Health Care Claim Additional Information Request
EDI 277 Health Care Claim Request for Additional Information
EDI 275 Additional Information to Support a Health Care Claim or Encounter
Transmission Explanation
| ST*275*0002*005010X211~ | Begin transaction set 275 based on implementation guide 5010X211, control number 0002. |
| BGN*02*20020926002*20050921*0629~ | This is an attachment to a health care services review request. The submitter transaction ID is “20020926002”. |
| NM1*1P*1*FITCH*ROBERT*DOUGLAS***XX*3999000086~ | • Loop 1000A. Information Source Name The information source for the information in the unsolicited attachment is Dr. Robert Douglas Fitch with the National Provider Identifier “3999000086”. |
| NM1*X3*2*ABC INSURANCE COMPANY*****PI*05440~ | • Loop 1000B. Information Receiver Name The receiver of this additional information is the UMO, ABC Insurance, payer ID “05440”. |
| NM1*QC*1*JONES*PETER*M***MI*123456789A~ | • Loop 1000D. Patient Name The patient is Peter M. Jones, Member ID “123456789A” |
| REF*2I*200209261~ | This attachment is associated with the provider’s patient event tracking number “200209261”. |
| LX*1~ | • Loop 2000A. Assigned Number This is the beginning of the first loop containing additional information |
| TRN*1*JONP56789001~ | This is the Attachment Control Number assigned by the provider. It also appears in PWK06 of the PWK segment of the 278 Health Care Services Review Request. |
| REF*ICD*73681~ | The attachment provides operative notes associated with the diagnosis code 736.81. |
| DTP*368*D8*20050926~ | • Loop 2100A. Date Additional Information Was Submitted This segment is required to use the BIN segment. It indicates the date the attachment is submitted to the UMO. |
| CAT*AE*TX~ | • Loop 2110A. Electronic Format Identification Identifies the content of the BIN segment as an attachment in HL7 CDA Human Decision Variant XML marked up, encoded in the ASCII format. |
| EFI*05~ | This segment is required and identifies the attached information as 05 Personal. Per public law publication 104- 191 August 21, 1996 Section 1177 [HIPAA] – This information is confidential and wrongful use is subject to penalties. |
| BIN*3117* <levelone xmlns=”urn:hl7-org:v3/cda” xmlns:v3dt=”urn:hl7-org:v3/v3dt” xmlns:xsi=”http://www.w3.org/2001/XMLSchema-instance” xsi:schemaLocation=”urn:hl7-org:v3/cda levelone_1.0.attachments.xsd”> <clinical_document_header> <id EX=”a123″ RT=”2.16.840.1.113883.3.933″/> <document_type_cd V=”11504-8″ DN=”Provider Unspecified Operative Note”/> <origination_dttm V=”2005-09-21″/> <provider> <provider.type_cd V=”PRF”/> <person> <id EX=”3999000086″ RT=”2.16.840.1.113883.4.6″/> <id EX=”RFD123″ RT=”2.16.840.1.113883.19.4.1″/> <person_name> <nm> <v3dt:GIV V=”Robert”/> <v3dt:FAM V=”Fitch”/> <v3dt:MID V=”Douglas”/> <v3dt:SFX V=”MD” QUAL=”PT”/> </nm> <person_name.type_cd V=”L” S=”2.16.840.1.113883.5.200″/> </person_name> </person> </provider> <patient> <patient.type_cd V=”PATSBJ”/> <person> <id EX=”JONP56789″ RT=”2.16.840.1.113883.19.4.2″/> <person_name> <nm> <v3dt:GIV V=”Peter”/> <v3dt:FAM V=”Jones”/> <v3dt:MID V=”M”/> </nm> <person_name.type_cd V=”L” S=”2.16.840.1.113883.5.200″/> </person_name> </person> <is_known_by> <id EX=”JONP56789″ RT=”2.16.840.1.1138863.19.4.2″/> <is_known_to> <id EX=”123456789A” RT=”2.16.840.1.113883.19.4.3″/> </is_known_to> </is_known_by> </patient> <local_header descriptor=”Att_ACN”> <local_attr name=”attachment_control_number” value=”JONP56789001″/> </local_header> </clinical_document_header> <body> <section> <caption>Date Surgery</caption> <paragraph> <content>2005-09-20</content> </paragraph> </section> <section> <caption>Pre-operative Diagnosis Narrative</caption> <paragraph> <content>Left leg length discrepancy</content> </paragraph> </section> <section> <caption>Post-operative Diagnosis Narrative</caption> <paragraph> <content>Left leg length discrepancy</content> </paragraph> </section> <section> <caption>Surgical Procedure Narrative</caption> <paragraph> <content>Right distal femoral epiphysiodesis</content> </paragraph> </section> <section> <caption>Anesthesia Narrative</caption> <paragraph> <content>General endotracheal</content> </paragraph> </section> <section> <caption>Fluids</caption> <paragraph> <content>500 cc of lactated ringer’s</content> </paragraph> </section> <section> <caption>Estimated Blood Loss Volume</caption> <paragraph> <content>300 cc</content> </paragraph> </section> <section> <caption>Surgical Drains</caption> <paragraph> <content>None</content> </paragraph> </section> <section> <caption>Complications</caption> <paragraph> <content>None</content> </paragraph> </section> <section> <caption>Surgery Description</caption> <paragraph> <content>The patient was brought to the operating room and placed supine on the operating table. Following the administration of general endotracheal anesthetic, a non-sterile tourniquet was placed on the patient’s right upper thigh. The patient’s right lower extremity was then prepped and draped in the normal sterile fashion. Attention was then turned to the right distal femoral epiphysis. Fluoroscopy was used to isolate the level of the epiphysis. An approximately 1 cm incision was then made on the lateral aspect of the distal thigh. Subcutaneous tissues were incised in line with the skin incision. The dissection was carried bluntly down to the lateral aspect of the femur. A Steinmann pin was then placed to cross the distal femoral site, this using fluoroscopy as a guide. The pin was then over drilled with a 9 mm and then an 11 mm drill bit. Dr. Davidson revascularized the fibular graft set. The Steinmann pin was then removed. The remaining portion of the epiphyseal plate was removed using an angled curette. Incision was made medially when the Steinmann pin was placed across the epiphyseal plate, which also measured approximately 1 cm. This was used to insert the curette to assist with destruction of the medial epiphyseal plate. One epiphyseal plate had been thoroughly destroyed, destruction was confirmed using fluoroscopy. The wounds were then thoroughly irrigated with normal saline containing bacitracin. Deep fascial layer was closed using figure-of-eight sutures of #0 Vicryl. Subcutaneous tissues were reapproximated using interrupted inverted sutures of 20 Vicryl. The skin was closed with a 4-0 subcuticular stitch. The wounds were cleaned and dried and dressed with Steri-Strips, Xeroform, sterile gauze, and a bulky Jones wrap. The tourniquet was deflated prior to application of the bulky Jones wrap. The patient was then placed in a knee immobilizer. There were no intraoperative complications. Dr. Fitch was present for the critical portion of the case. The patient was successfully extubated and transported to the recovery room in stable condition.</content> </paragraph> </section> <section> <caption>Provider Signing Name</caption> <paragraph> <content>Robert Douglas Fitch, MD</content> </paragraph> </section> <section> <caption>Surgeon Resident Name</caption> <paragraph> <content>Robert Douglas Fitch, MD</content> </paragraph> </section> <section> <caption>Surgeon Staff Name</caption> <paragraph> <content>Samuel David Stanley, MD and James D. Davidson, MD</content> </paragraph> </section> <section> <caption>Provider Dictating Practitioner Name</caption> <paragraph> <content>Samuel David Stanley, MD</content> </paragraph> </section> </body> </levelone>~ | Binary Data Segment. Data length (3117) |
| SE*14*0002~ | Number of segments. Control number |
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