As we prepare for potential regulatory proposed standards for electronic attachments, Empire will be implementing the X12 275 5010 version electronic attachments transactions for claims.

 

Standard electronic attachments will bring value to you by eliminating the need for mailing paper records and reduced processing time overall. 

 

Empire and Availity will be piloting EDI batch electronic attachments with previously selected providers.  Both solicited and unsolicited attachments will be included in our pilots.

 

Solicited Attachment- Provider sends a claim and Payer determines there is not enough information to process the claim.  Payer will then send the provider a request for additional information (currently via letter).  Provider can then send the solicited attachment transaction with the documentation requested to process the claim.

 

Unsolicited Attachment- When the provider knows that the payer requires additional information to process the claim, the provider will then send the X12 837 claim with the “Paper Work Included” (PWK) segment tracking number.  Then the provider will send the X12 275 attachment transaction with the additional information and include the tracking number that was sent on the claim for matching.

 

What you can do now:

Start having conversations with your Clearinghouse and/or Electronic Healthcare Records (EHR) vendor to determine their ability to set up the X12 275 attachment transaction capabilities. 

 

Look for more information around general availability of this exciting option later this summer with details on how to work with Empire and Availity to send your attachments via electronic batch.



Featured In:
June 2019 Empire Provider Newsletter