Submit Medical Record Documentation Electronically

Submit Medical Record Documentation Electronically
Related Content

Submit Medical Record Documentation Electronically

Medicare providers can now submit their medical record documentation electronically, whether attached to the original claim submission or in response to a documentation request.

National Government Services utilizes the X12 275 Attachment transaction to allow providers to submit additional documentation electronically. Clinical documentation includes but is not limited to operative notes, consult notes, lab results, procedure notes, care plans.

This claim attachment transaction can be sent to NGS either on an unsolicited basis or a solicited basis:

An unsolicited basis is when the provider needs to attach documentation at the same time the Medicare claim is submitted. NGS has specific criteria when documentation should be attached to a claim. See below for a list of services that may require clinical information to accompany a claim. Please be aware that documentation is only necessary in limited situations.
A solicited basis is when you need to respond to a request for medical records. NGS may need to request additional information with regard to claims submitted to the Medicare Program. The requests for additional information letters are called additional development requests. To learn more about the ADR process, see the NGS Additional Development Request Letter Guide.

NGS has a complete electronic end-to-end solution in place for supporting documentation requests for all lines of business. The benefits of the electronic attachment program include:

Eliminates paper - Reduces administrative burden associated with the paper process of printing and mailing.
Providers who are utilizing the claim attachment feature are reporting up to a 50% reduction in claim status calls and up to 50% reduction in Medical Review denials.
Participating providers are reporting being paid up to 30 days sooner.
ADRs can be sent electronically to the provider, instead of NGS mailing the additional documentation letter. The X12 277 Request for Additional Information transaction allows us to send the ADRs electronically through your current billing process – no paper ADR. This saves time and makes sure the documentation request is received in your practice.
You know when Medicare receives the attachments: When you submit your medical records electronically, an acknowledgement transaction is generated which provides you with an immediate receipt for the documentation.
Reduces administrative burden
Reduces denials
Improves payment revenue cycles

Using the Electronic Attachment Program will help you get paid faster and simplify some of the administrative load. Check with your EMR vendor and/or clearinghouse about the 275 and 277 transactions.

[Return to Top]

What do you need to get started?

Contact your software vendor, system maintainer or clearinghouse to determine if they can support this transaction.
Vendor support to receive the 6020 version of the 277 Request for Additional Information transaction.
Vendor support to create either the HL7 CDA R2 (unstructured) or HL7 C-CDA R2.1. (Structured Operative Note template or Unstructured Document)
Download and review the NGS Companion Guides (275 and 277 Request for Additional Information)
Enrollment for the 275 electronic attachment transaction and/or the 277 Request for Additional Information at EDI Enrollment Process User Guide.
NOTE: You are not required to enroll for the 275 and 277 transactions at the same time, the transactions aren’t dependent on one another.

The 275 Transaction Companion Guide and the 277 Request Additional Information Companion Guide are available on the EDI Solutions web page.

Contact EDI Helpdesk with any questions.

J6 : 877-273-4334
JK: 888-379-9132

[Return to Top]

What are the Attachment Transactions?

The X12 277 Healthcare Claim Request for Additional Information transaction – replaces the paper ADR letters.
The X12 275 Additional Information to Support a Healthcare Claim or Encounter transaction – replaces the paper documentation supporting the claim.

[Return to Top]

Who can use the Attachment Transactions?

The 277 and 275 transactions are available for Part A and Part B providers.

[Return to Top]

Why use the Electronic Attachment Transactions

The 277 transaction
- Expedites the receipt of the documentation requests.
- Allows for the request to be routed to the appropriate person/department, eliminating lost or misdirected requests.
- Facilitates a quicker turnaround time of the response.
The 275 transaction
- Allows the provider to send the additional documentation at the same time the claim is submitted.
- Generates an electronic acknowledgement (999 transaction) which provides an audit trail of the receipt of the documentation.
- Eliminates lost or misdirected documentation.
The 277 and 275 transactions together
- Reduce administrative costs associated with manual processing.
- Expedite the revenue cycle process allowing the provider to be paid sooner and reduces the number of claim status calls.
- Provider’s participating in the NGS Electronic Attachment Program are reporting up to a 50% reduction in Medical Review claim denials and report receiving payments up to 30 days sooner

[Return to Top]

Services that require documentation to be submitted (unsolicited) with the claim.

NGS will only review additional documentation when it is necessary to process a claim. The circumstances listed here may require additional information which may be submitted by utilizing:

the PWK segment in the claim (for additional information, visit Medicare Part B PWK) , and
responding to a request for documentation using the 275 electronic attachment transaction.

Part B unsolicited criteria:

Surgical NOC Procedure Codes: A description of the NOC should be entered on the electronic claim in the comment field. If unable to adequately describe, an operative report is required. If multiple services are submitted, the information submitted should clearly indicate which service the NOC code applies.
Nonsurgical NOC Procedure Codes: A detailed description of the procedure must be provided in the comment field.
Drugs and Biologicals NOC Codes: An invoice is required for certain drugs/products. This may be entered on the electronic comment field. For NOC codes, a detailed description of the drug name and dosage must be provided in the comment field of the claim. If this is done, no separate attachment is required.
Modifier 22‒ Unusual Services: Services submitted with the 22 or 66 modifier requires a clear concise statement and the operative notes. Always attempt to explain the reason for the modifier 22 in the comment field. If you feel there is not enough space to sufficiently describe the reason, an operative report is required with a concise statement about how the service differs from the usual.
Modifier 53 ‒ Discontinued Services: An operative report is required for surgical procedures if unable to explain in the claim comment. Colonoscopies are exempt from requiring documentation for modifier 53.
Modifier 62 ‒ Cosurgery: An operative report is required from both surgeons and must demonstrate the medical necessity for two surgeons if the cosurgery indicator on the Medicare Fee Schedule Database is a 1, which is defined as: cosurgeons could be paid; supporting documentation required to establish medical necessity of two surgeons for the procedure.
Modifier 66 ‒ Team Surgeons: An operative report is always required for the team concept.
Modifier GM ‒ Ambulance Multiple Patients on One Ambulance Trip: Documentation to specify the particulars of a multiple patient transport. Documentation must include total number of patients transported at same time and HICN/MBI for each beneficiary.
Claims submitted with procedure codes 21031, 21032, 21110, 30120, 30400, 30410, 30420, 30430, 30435, 30450, and 69300 require medical necessity documentation.
Services submitted with AS, 80, 81 and 82 modifiers and the procedure code has an assistant surgery indicator of 0 require the operative notes. Assistant surgery indicator of 0 indicates the payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
Claims submitted with greater than five surgeries on the date of service.
Claim scenarios that require additional documentation, as identified by the provider’s billing history.

[Return to Top]

Excessive Documentation

It’s imperative, when submitting documentation electronically that only the documentation relevant to the service provided is submitted for review.

NGS will never need the beneficiary’s entire patient admission/chart record for a PWK submission or a claims ADR.

Submitting excessive documentation can lead to:

Increased administrative costs
Claim denials
Delay in claim processing

[Return to Top]

Services that require documentation to be submitted (unsolicited) with the claim.

In most instances, when a modifier, dose, etc. can be described in the comment field of the electronic submission there is not a need for additional documentation.

The following services listed below are examples of those that wouldn’t require documentation:

Molecular lab tests
Hemophilia drugs under the MUE
Drugs that have a clear name and dosage in the description
- For example, Pepcid 20 mg or CPT 93799 (terminology is reported as APBM less than 24 hours)

[Return to Top]

Submit Medical Record Documentation Electronically

Table of Contents