Table 3: Request Attachment Activity Request Unique Attachment ID Healthcare Administrative Assigning Attachment Activity Mode Timing Actor Reassociation Activity Basis After Claim is Payer Request Request for received and and provider Solicited additonal information reviewed by Payer Attachment Claim In advance of Claim Provider Claim Pre-defined Rules Provider Unsolicited submital and Attachment After Prior Request for Payer Request Authorization is additional Payer and provider Solicited received and information Attachment reviewed by Payer Prior Authorization Provider Prior In advance of Prior Authorization Pre-defined Rule Authorization Provider Unsolicited request and Request submittal Attachment Request for After Referral is Payer request and additional received and Payer provider Solicited information reviewed by Payer Attachment Provider referral Referral request and In advance of Based Provider additional Unsolicited Referral information submittal Attachments ASC X12N Activity There are multiple standards available in the industry to accomplish the exchange of information for attachment purposes (e.g., request, response, acknowledgement). describes the scenarios addressed for Attachment exchange purposes. Table 4 shows the correlation to each of the Activity ID’s with an ASC X12 Transaction Set. The version that should be used of the ASC X12N Technical Reports published for the purposes of exchanging Attachments is the version named in regulation or agreed by trading partners in the absence of regulations. To better understand the relationship of the row values for each attachment activity, a interpretation “table template” was developed: Descriptions of the Column headings and table values are: Healthcare Administrative Activity The type of healthcare administrative activity of the originating actor for the activity type. ‘request’
Table 3: Request Attachment Activity Healthcare Administrative Activity Request Unique Attachment ID Attachment Activity Basis Mode Timing Assigning Actor Reassociation Claim Request for additonal information After Claim is received and reviewed by Payer Payer Request and provider Attachment Solicited Pre-defined Rules In advance of Claim submital Provider Provider Claim and Attachment Unsolicited Prior Authorization Request for additional information After Prior Authorization is received and reviewed by Payer Payer Payer Request and provider Attachment Solicited Pre-defined Rule In advance of Prior Authorization Request submittal Provider Provider Prior Authorization request and Attachment Unsolicited Referral Request for additional information After Referral is received and reviewed by Payer Payer Payer request and provider Attachment Solicited Based In advance of Referral Provider Provider referral request and additional information submittal Unsolicited Attachments ASC X12N Activity There are multiple standards available in the industry to accomplish the exchange of information for attachment purposes (e.g., request, response, acknowledgement). describes the scenarios addressed for Attachment exchange purposes. Table 4 shows the correlation to each of the Activity ID’s with an ASC X12 Transaction Set. The version that should be used of the ASC X12N Technical Reports published for the purposes of exchanging Attachments is the version named in regulation or agreed by trading partners in the absence of regulations. To better understand the relationship of the row values for each attachment activity, a “table interpretation template” was developed: Descriptions of the Column headings and table values are: Healthcare Administrative Activity The type of healthcare administrative activity of the originating actor for the ‘request’ activity type.
20160315%20HL7%20Attachment%20Supplement%20Specification%20Release%202%20Version%204.0.docx