An attachment, in the context of healthcare electronic data interchange, is an electronic rendition of medical documentation, such as an X-ray, lab report, or questionnaire, that supports a healthcare administrative transaction.
An attachment can be unstructured, such as an Adobe® PDF file, WORD, TEXT or images using jpg, or tiff. The standards development organization Health Level 7 International (HL7) has developed standards for the clinical data in both types of attachments. This standard is HL7 Clinical Document Architecture (CDA). HL7 has also developed an HL7 CDA® R2 Attachment Implementation Guide: Exchange of C-CDA Based Documents, Release 1 - US Realm for using the C-CDA for Attachments.
Two ASC X12N transactions allow the receiver of a claim or Health Services Review to ask for supporting documentation:
The Health Care Claim Request for Additional Information (277RFAI) is used to request supporting documentation for a claim.
The Health Care Services Review – Request for Review and Response (278RR) is used to request documentation supporting a prior authorization, referral, or admission review.
Two ASC X12N 275 transactions allow attachments to be sent electronically, either unsolicited (without a request from the receiver) or in response to a request for supporting documentation:
The Additional Information to Support a Health Care Claim or Encounter (275) is used to send attachments related to a healthcare claim.
The Additional Information to Support a Health Care Services Review (275) is used to send attachments related to a health care services review or review notification.