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Back   Additional Information to Support a Health Care Services Review (006020X316)

Purpose

The Additional Information to Support a Health Care Claim or Encounter Implementation Guide describes the use of the ASC X12 Patient Information (275) transaction set for the following business usage:
  • To assist those who send additional supporting information or who receive additional supporting information to a health care claim services review.

Primary Trading Partners

Entities that use this implementation of the 275 include, but are not limited to:
  • Insurance Companies
  • Utilization Management Organizations (UMO)
  • Third Party Administrators (TPA)
  • Managed Care Service Organizations (HMO),
  • State and Federal Agencies and their contractors
  • Plan Purchasers
  • and any other entity that processes health care service review.
Other business partners affiliated with with the 275 include, but are not limited to:
  • Consulting Services
  • Vendors of Systems Software, EDI translators, and EDI network intermediaries such as authomated clearing houses (ACHs), value added networks (VANs), and telecommunications services.

    References

    • Additional Information to Support a Health Care Services Review (004050X147)
    • Additional Information to Support a Health Care Services Review (005010X211)
    • Additional Information to Support a Health Care Services Review (006020X278)

    Coordination

    ASC X12N/TG2/WG10 - The unsolicited and solicited models for attachments work in conjunction with the 278 Health Care Services Review. Coordination will occur with WG10 to ensure sybchronization of the two Implementation Guides.

    Health Level Seven (HL7) - This implementation guide describes a solution that includes the encapsulation of the Health Level Seven (HL7) Clinical Document Architecture (CDA) Standard within the binary segment to support the exchange of the additional information needed to support a health care claim services review.

    Additional Information

    Registered 9/24/2013 Published 9/25/2014
    Transaction Set ID 275 Standard Version 006020
    ASC X12 DM# Owning Group X12N/TGC/WG3