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X12 transaction guide · Healthcare and insurance

EDI 275 Patient Information

The X12 document used to request and send individual patient information between health care entities, solicited or unsolicited.

Sent by
Health care provider, payer or other entity
Received by
Health care provider, payer or other entity
Standard
ANSI ASC X12

What is an EDI 275?

The EDI 275 Patient Information is the ANSI X12 transaction set used to communicate requests for individual patient information, and the patient information itself, whether solicited or unsolicited, between separate health care entities in a variety of settings.

A common use is sending supporting documentation with or after a claim, such as clinical notes or reports that a payer needs to process it. The 275 can carry such attachments in electronic form, replacing faxed or mailed records. Its use for claim attachments depends on the rules in force in each market.

How the EDI 275 worksDiagram of the EDI 275 Patient Information. Health care provider, payer or other entity sends it to health care provider, payer or other entity. It usually follows 277. It is usually followed by 997. Inside the ISA, GS and ST envelopes, X12 release 008010 requires, in the . 2 optional loops are listed by their first segment.How the EDI 275 worksPatient Information: who sends it, where it fits and what the standard marks required1 WHERE IT FITSUSUALLY FOLLOWS277Health Care InformationStatus NotificationEDI 275SENDERHealth care provider,payer or other entityRECEIVERHealth care provider,payer or other entity997 or 999 acknowledgment back, if the partners agreeUSUALLY FOLLOWED BY997FunctionalAcknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDsISA … IEAFunctional group, ID code PIGS … GETransaction set 275ST … SEHEADING+ 1 optional loop, starting with:NM1DETAIL+ 1 optional loop, starting with:LXBlue box: required loop. Optional loops are listed by the segment that starts them; when a loop is used, that first segment is required. Optional segmentsoutside loops are not drawn.Structure: required segments and loops in the X12 008010 listing for the 275. Your trading partner's implementation guide adds its own requirements.
How the EDI 275 worksDiagram of the EDI 275 Patient Information. Health care provider, payer or other entity sends it to health care provider, payer or other entity. It usually follows 277. It is usually followed by 997. Inside the ISA, GS and ST envelopes, X12 release 008010 requires, in the . 2 optional loops are listed by their first segment.How the EDI 275 worksPatient Information: who sends it, where it fitsand what the standard marks required1 WHERE IT FITSUSUALLY FOLLOWS277Health Care Information StatusNotificationEDI 275SENDERHealth careprovider, payeror other entityRECEIVERHealth careprovider, payeror other entity997 or 999 acknowledgment back, if the partnersagreeUSUALLY FOLLOWED BY997Functional Acknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDs (ISA… IEA)Functional group, ID code PI (GS … GE)Transaction set 275 (ST … SE)HEADING+ 1 optional loop, starting with:NM1DETAIL+ 1 optional loop, starting with:LXBlue box: required loop. Optional loops are listedby the segment that starts them; when a loop isused, that first segment is required. Optionalsegments outside loops are not drawn.Structure: required segments and loops in the X12008010 listing for the 275. Your trading partner'simplementation guide adds its own requirements.

How to read this diagram: the top row shows who sends the 275, to whom, and which documents usually come before and after it. The lower part shows what X12 release 008010 itself requires: the envelopes around the 275 and the segments and loops the standard marks as required, area by area. Optional loops are listed by the segment that starts them rather than drawn in full. This is the standard's minimum, not a trading partner's requirement: each partner's implementation guide usually makes some optional loops mandatory, restricts the codes and may use a different release.

Expand diagram Download SVG

When it is used

  • Sending claim attachments to payers
  • Responding to requests for additional documentation
  • Exchanging patient information between providers

Where it fits in the document flow

Usually follows 277 Health Care Information Status Notification
This document 275 Patient Information
Usually followed by 997 Functional Acknowledgment

Structure

Mandatory segments in the 275 (X12 release 008010)

The segments X12 release 008010 marks as mandatory at their level, in order. Segments inside optional loops are needed only when the loop is used. This is the standard's requirement, not your trading partner's: each partner's implementation guide names the release it uses, adds the optional segments it requires and restricts the values. The requirement status comes from one published X12 reference listing and has not been checked against a second source.

  • ST
  • NM1
  • NX1
  • LX
  • DTP
  • OOI
  • BDS
  • SE

Practical example

The 275 in practice

A payer needs operative notes to process a surgical claim and requests them from the hospital. The hospital sends a 275 with the notes attached and the claim reference. The payer's claims system links the attachment to the claim and completes adjudication.

Implementation

Implementation considerations for the 275

  • Protect patients' health information under applicable law.
  • Link attachments to the right claim and patient.
  • Check the attachment rules in force in your market.
  • Send only the information requested or necessary.

How ECOM helps

Automate the 275 with ECOM

Industry

Healthcare

Secure B2B integration and file transfer for providers, suppliers, distributors and healthcare partners.

Solution

Intelligent Document Processing

Automate data capture from PDFs, emails and spreadsheets with validation and human review.

Solution

EDI Integration

Exchange X12 and EDIFACT documents with partners and integrate them directly with your ERP.

More general questions about EDI are answered in the EDI FAQ.

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