Submit a 275 claim attachment transaction

AmeriHealth Caritas District of Columbia (DC) is accepting ANSI 5010 ASC X12 275 unsolicited attachments via Change Healthcare. Please contact your practice management system vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 attachment submissions via payer ID: 77002.

There are three ways that 275 attachments can be submitted.

  • Batch — You may either connect to Change Healthcare directly or submit via your EDI clearinghouse.
  • API via JSON — You may submit an attachment for a single claim.
  • Portal — Individual providers can register at Change Healthcare to submit attachments.

The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, xml, doc, and txt. View the Change Healthcare 275 claims attachment transaction video for detailed instructions on this new process.

In addition, the following 275 claims attachment report codes have been added effective 8/1/23. When submitting an attachment, use the applicable code in field number 19 of the CMS 1500 or field number 80 of the UB04, as documented in the claims filing instructions (PDF).

Attachment type Claim assignment attachment report code
Itemized bill 03
Medical records for HAC review M1
Single case agreement (SCA)/LOA 04
Advanced beneficiary notice (ABN) 05
Consent form CK
Manufacturer suggested retail price/Invoice 06
Electric breast pump request form 07
CME checklist consent forms (child medical eval) 08
EOBs – for 275 attachments should only be used for non-covered or exhausted benefit letter EB
Certification of the decision to terminate pregnancy CT
Ambulance trip notes/Run sheet AM