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.
EDI 275 Patient Information in Data Mapper
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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
- 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
EDI 275 Workflow Example
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The EDI 275 Additional Patient Information (Solicited or Unsolicited) may be sent with attachments in an EDI 837 Claim workflow.
Providers or third-party services send the EDI 837 Healthcare Claim to payers. The optional EDI 275 Additional Patient Information (Unsolicited) may also be sent with attachments. The payer or clearinghouse system returns an EDI 999 Implementation Acknowledgment to confirm receipt of the incoming EDI 837 Healthcare Claim. The payer may send an EDI 277 Claim Acknowledgement of all claims received in the payer’s pre-processing system.
An EDI 276 Claim Status Request is sent to verify the status of the claim. The EDI 277 Claim Status Response is sent by the payer. The payer may also send an EDI 277 Request for Additional Information. The EDI 275 Additional Information (Solicited) is sent in response and may include patient record attachments.
With aspects of the claim verified, the payer sends the EDI 277 Claim Pending Status Information. The EDI 835 Claim Payment/Advice is used to make payments to healthcare providers and/or provide Explanations of Benefits (EOBs). The EDI 835 is used to detail and track the payment to the claim.
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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