275 Patient Information (X210)

- Required when the value in BGN01 is 11 and the Payer Response Contact Information (PER Segment) was reported in the 2210D loop of the 277 transaction. If not required by this implementation guide, do not send. - When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number should always include the area code and phone number using the format AAABBBCCCC. Where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number (e.g. (534)224-2525 would be represented as 5342242525). The telephone extension, when applicable, should be included in the next sequential communication number data element.

- In the solicited 275 model, the information from the 2100C NM1 segment of the 277 must be returned in this segment. - In the unsolicited 275 model, the billing provider information must be sent in this segment.

- Required when the payer's adjudication is known to be impacted by the provider taxonomy code. If not required by this implementation guide, do not send.

- Required when the provider is not covered under the NPI mandate. If not required by this implementation guide, do not send.

- When the value in BGN01 of the 275 is 02, the Patient Control Number must be the same number as reported in CLM01 of the 2300 loop in the 837. When the value in BGN01 is 11, the Patient Control Number must be the same number as reported in REF02 of the 2200D loop in the 277.

- Required when the Institutional Type of Bill from the submitted claim is available in the payer's system and is included in the 2200D REF segment of the 277. If not required by this implementation guide, do not send.

- Required when the Medical Record Identification Number is submitted on the original claim. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.

- Required when this claim identification number is sent in the 2200D REF segment of the 277. If not required by this implementation guide, do not send. - Although this REF is supplied for transmission intermediaries to attach their own unique claim number to a claim/encounter, trading partners are not required under HIPAA to return this number in any HIPAA transaction. Trading partners may voluntarily agree to this interaction if they wish.

- Required when the information submitted or requested applies to the entire claim. If not required by this implementation guide, may be provided at the sender's discretion but can not be required by the receiver.

- Within the LX, LX01 is the sequence number of the segments that follow. The LX01 sequence number must start at 1 and increment by 1. - The LX segment can be repeated to respond to multiple questions on an individual claim. The 275 transaction structure only allows the submitter to send one claim in each 275. A separate Transaction Set Header/Trailer (ST/SE) must be sent for each claim.

- Payer Claim Control Number is the value from the TRN segment loop 2200D of the 277 when in response to a solicited request. - The TRN02 value must be the same in each iteration of the 2000A loop when the value in TRN02 is the Payer claim control number. - For the unsolicited 275, the Attachment Control Number is the value from PWK06 loop 2300 of the 837. This is the main matching criteria and must be unique on a per attachment basis.

- Required when the value in BGN01 is 11 (Response). If not required by this implementation guide, do not send.

- Required when the additional information is associated with the service line or revenue line information. If not required by this implementation guide, do not send. - If this segment is used, then there will be a REF segment that contains the Procedure Code or Revenue Code.

- This segment will convey service line or revenue code information that is associated with the additional information. This matches the value in the 837 SV101-2, SV201-2, or SV301-2 or the 277 SVC01-2 or SVC04. - Required when the additional information is associated with the service line or revenue line information. If not required by this implementation guide, do not send.

- Required when the procedure code submitted on the original claim include modifiers. If not required by this implementation guide, do not send. - The procedure code modifiers should be reported in the same order as on the original claim.