As we prepare for potential regulatory proposed standards for electronic attachments, we will be implementing what is called the X12 275 5010 version of 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. 

 

Anthem and Availity will be piloting Electronic Data Interchange (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 the payer determines there is insufficient information to process the claim.  Payer then sends 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 then sends the X12 837 claim with the “Paper Work Included” (PWK) segment tracking number.  Next, the provider sends the X12 275 attachment transaction with the additional information and includes the tracking number that was sent on the claim for matching purposes.

 

What you can do now

We encourage you to 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 about the general availability of this time-saving option later this summer and details on how to work with Anthem and Availity to send your attachments via electronic batch.



Featured In:
June 2019 Anthem Connecticut Provider Newsletter