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

Purpose

The Request for Medical Information and Reports in Support of a Disability or Workers' Compensation Claim Implementation Guide describes the use of the Health Care Information Status Notification (277), Version/Release 004050 Transaction Set for the following business usages:
  • Request that existing medical information related to a claim for disability benefits or workers' compensation benefits be sent from an information source, such as a medical provider, to a payer or payer's agent, such as a disability determination organization, for the purpose of supporting a claim for disability benefits or workers' compensation benefits or other related determinations.
  • Request that a medical provider perform a service and transmit reports of that service to an information receiver, such as a payer or disability determination organization, for the purpose of supporting a claim for disability benefits or workers' compensation benefits or other related determinations.
  • Request further information or report about the status of a previous request for medical information and reports in support of a Disability or Wrokers' Compensation claim.

Primary Trading Partners

Trading partners include:
  • Insurance carriers providing disability coverage
  • Workers' Compensation carriers
  • Disability determination services of states, territories, and the Social Security Administration
  • Health care providers
  • Medical records management organizations
  • Clearinghouses

Exceptions/Limitations

This guide does not replace or serve in place of guides to request clinical information in support of a health care claim from a provider to a payer.

References

This is the first implementation guide for this business purpose.

Coordination

ASC X12N Workers' Compensation/Disability Work Group (TG1/WG3) and Health Care Claim Status (TG2/WG5)

Additional Information

Registered 10/1/2001 Published 1/1/2003
Transaction Set ID 277 Standard Version 004050
ASC X12 DM# Owning Group X12N/TG1/WG3