275 Attachments (Batch EDI) Companion Guide

Disclosure

This document contains proprietary information of Optum and is intended for use by authorized trading partners only.

Optum provides the information in this document for business processes education and awareness. We wrote this with the goal to provide our customers with the complete information to successfully deliver and manage Unsolicited Version 5010 ASC X12 275 batch attachment submissions. While Optum believes all information in this document to be accurate at the time of writing, it is intended for educational purposes only, and we cannot warranty its accuracy or completeness. The information in this document is for reference use only. We also observe the "If not required by this Guide, do not send" standard set forth in the X12 standards guides.

Also, the listing of an organization in this document doesn't imply an endorsement, business relationship or recommendation. Optum takes no responsibility for any third-party tools, products, or Internet web sites that we may mention in this document. Existence of a link or organizational reference in any part of this Guide is not an endorsement by Optum.

The ASC X12 Technical Reports Type 3 (TR3s) defines rules for the format, content, and data element of 5010 ASC X12 transactions. These guides are available on the X12.Org website; for licensing information, see here.

This document supplements the ASC X12 TR3s for Optum customers and describes aspects of the Optum network environment, use cases, interchange requirements, transaction responses, acknowledgements, and reporting for each of the transaction types specified in this guide as they are related to Optum. This guide also documents specific information for data elements and values required by Optum.

For this document's purposes, readers must have a subscription to Washington Publishing Company and to the 275 and 999 TR3 Guides, along with the appropriate 837 TR3 Guides.

This Companion Guide is intended to convey information that is within the framework of the ASC X12N Implementation Guides adopted for use under HIPAA.

It does not exceed or replace the requirements specified in the TR3s. Rather, it provides clarification, usage guidance, and Optum-specific constraints for trading partners exchanging transactions with Optum.

Purpose of this Companion Guide

This Companion Guide provides implementation-specific requirements for submitting ASC X12N 275 Additional Information to Support Claims or Prior Authorization Requests transactions. This Companion Guide is intended to convey information that is within the framework of the ASC X12N Implementation Guide adopted for use under HIPAA and does not exceed its requirements.

It supplements, but does not replace:

• ASC X12N 005010X210 — Claims/Encounters
• ASC X12N 005010X211 — Prior Authorization/Service Review

These implementation guides define the core transaction structure, while this Companion Guide specifies Optum-specific expectations, usage, and constraints.

The 275 transaction is used to submit supporting documentation for:

• Healthcare claims submitted using 837
• Healthcare service review or prior authorization transactions submitted using 278

Scope

This guide does not apply to transactions outside of supported attachment flows or to unsupported claim types as defined by Optum.

This guide applies to:

• Batch file-based EDI submissions only
• SFTP or clearinghouse transport
• Attachments supporting:
  • 837 claims
  • 278 prior authorization or service review transactions

This guide does not describe real-time API submission.

This Companion Guide is intended to convey information that is within the framework of the ASC X12N Implementation Guides adopted for use under HIPAA.

It does not exceed or replace the requirements specified in the TR3s. Rather, it provides clarification, usage guidance, and Optum-specific constraints for trading partners exchanging transactions with Optum.

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NOTE — Legacy Relay Health Clients

This requirement applies only to legacy Relay Health trading partners and should be confirmed with Optum prior to implementation.

Supported capabilities

• Claim attachments
• Prior authorization attachments
• Solicited attachment flows
• Unsolicited attachment flows

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NOTE

Optum may translate 005010X210 transactions to 006020X314 format based on downstream payer requirements. Trading partners are not required to submit 006020 transactions.

References

• ASC X12N 005010X210
• ASC X12N 005010X211
• ASC X12N 005010X210 TR3
• ASC X12N 005010X211 TR3
• X12.org licensing and standards