Back   Request for Information in Support of a Disability Claim (005010X227)


This is the 005010 version of the ASC X12N 004050 version (004050X164). This guide allows Disability Insurers, Processors, Reviewers, and their Agents to request medical documentation, tests, examinations or other evidence in support of a disability claim. Allows request for status of unsolicited request.

Primary Trading Partners

Trading partners include: <UL> <LI>Insurers <LI>Government Agencies <LI>Medical Review Organizations <LI>Health Care Providers </UL>


  • Request for Medical Information and Reports in Support of a Disability or Workers Compensation Claim (004050X164)


ASC X12N Workgroup:
  • Health Care Claim Request for Additional Information (TG2/WG5)
  • Claims Attachment Work Group (TG2/WG9)

Additional Information

Registered 2/4/2004
Transaction Set ID 277 Standard Version 005010
ASC X12 DM# 077204 Owning Group X12N/TG1/WG3