The HIPAA Administrative Simplification provision mandates the adoption of standards for electronic claims attachments. A claims attachment includes the clinical and administrative information often necessary to adjudicate claims such as those for ambulance, rehabilitation, or emergency room services. Regenstrief has worked closely with the HL7 Payer/Provider Information Exchange (PIE) Work Group (formerly called the “Attachments” Work Group) to support the use of LOINC codes in the electronic exchanges of attachments between payers and providers.

The current proposed specifications for attachments use LOINC codes for three main purposes:

  1. To identify the specific kind of information being communicated in both a request and response (e.g., a discharge summary or diagnostic imaging report).
  2. To specify certain optional modifier variables for fulfilling the request for information (e.g. variables that indicate a modification to the default time period).
  3. In structured attachment responses using HL7 CDA, LOINC codes identify the attachment (document) type, sections, and sometimes the individual entries (tests or observations).

In the LOINC table structure, all attachments have a numeric CLASSTYPE equal to 3. These LOINCs are often represented with a paperclip icon for easy identification.

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