Table 4: ASC X12N Attachment Activity Attachment Activity ASC X12N Basis Healthcare Example Envelope/ Originator Activity Type Figure Transaction ID Activity ID Standard Originator Receiver Example #1 Request X Payer Provider 2771 Claims #2 Response X Provider Payer 2752 Attachment #3 Attachment Submission X Provider Payer 2752 #4 Request X Payer Provider 2783 Prior Auth #5 Response X Provider Payer 2754 Attachment #6 Attachment Submission X Provider Payer 2754 Payer/ #7 Request X Referred To Provider 2783 Referring Provider Referral #8 Response X Referred To Provider 2754 Attachment Referring Provider #9 Attachment Submission X Referred To Provider 2754 Referring Provider Post #10 Request X Payer Provider 2771 Adjudicated Claim #11 Response X Provider Payer 2752 Attachment Notification #12 Attachment Submission X Facility provider Primary care provider 2754 Attachment 1 ASC X12N 277 Health Care Information Status Notification - Technical Report Type 3 for Health Care Claim Request for Additional Information – 2 ASC X12N 275 Patient Information Technical Report 3 for Additional Information to Support a Health Care Claim or Encounter – – 3 ASC X12N 278 Health Care Services Review Information Technical Report 3 for Health Care Services Request for Review and Response – 4 ASC X12N 275 Patient Information Technical Report 3 for Additional Information to Support a Health Care Service Review – –
Table 4: ASC X12N Attachment Activity Healthcare Activity ID Originator Activity Type Attachment Activity Basis Example Figure ID ASC X12N Envelope/ Transaction Standard Example Originator Receiver Claims Attachment #1 Request X Payer Provider 2771 #2 Response X Provider Payer 2752 #3 Attachment Submission X Provider Payer 2752 Prior Auth Attachment #4 Request X Payer Provider 2783 #5 Response X Provider Payer 2754 #6 Attachment Submission X Provider Payer 2754 Referral Attachment #7 Request X Payer/ Referring Provider Referred To Provider 2783 #8 Response X Referred To Provider Referring Provider 2754 #9 Attachment Submission X Referred To Provider Referring Provider 2754 Post Adjudicated Claim Attachment #10 Request X Payer Provider 2771 #11 Response X Provider Payer 2752 Notification Attachment #12 Attachment Submission X Facility provider Primary care provider 2754 1 ASC X12N 277 – Health Care Information Status Notification - Technical Report Type 3 for Health Care Claim Request for Additional Information 2 ASC X12N 275 – Patient Information – Technical Report 3 for Additional Information to Support a Health Care Claim or Encounter 3 ASC X12N 278 – Health Care Services Review Information Technical Report 3 for Health Care Services Request for Review and Response 4 ASC X12N 275 – Patient Information – Technical Report 3 for Additional Information to Support a Health Care Service Review
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