Additional Information to Support a Health Care Claim or Encounter (275)


Worker’s Compensation

Minnesota

State Farm® Worker's Compensation will receive the following electronic claim attachment transaction that must be exchanged as per the state of Minnesota mandate.

Additional Information to Support a Health Care Claim or Encounter Support - ASC X12N 275(005010X210)


Other Mandated States

State Farm Worker's Compensation will receive the following electronic claim attachment transaction that is optional per various state mandates. State Farm Worker's Compensation will also receive claim attachments by fax or through the mail.

Additional Information to Support a Health Care Claim or Encounter Support - ASC X12N 275(005010X210)

Fax Number – (844) 236-3646


Non-Mandated States

State Farm Worker's Compensation will receive claim attachments by fax or through the mail. The following fax number is available to send attachments for worker’s compensation bills.

Fax Number – (844) 236-3646




Auto

Minnesota

Currently, there is not a state mandate in Minnesota for receiving electronic claim attachments for electronic auto medical bills.  State Farm Auto will receive claims attachments by fax or through the mail.  The following fax number is available to send attachments for electronic auto medical bills.

Fax Number – (855) 820-6318


Non-Mandated States

State Farm Auto will receive claim attachments by fax or through the mail.  The following fax number is available to send attachments for auto bills.

Fax Number – (855) 820-6318


Sending Electronic Claim Attachments Transactions

State Farm Worker's Compensation uses a connection with the Utah Health Information Network (UHIN) to receive electronic claim attachment transactions. State Farm Worker's Compensation only accepts electronic claim attachment transactions that contain the binary data in the PDF, TIF, or JPEG format.

Please refer to our 275 companion guide, for the additional requirements on sending State Farm Worker's Compensation electronic claim attachment transactions, "SF 275 Companion Guide".

Providers and Electronic Data Exchange (EDI) clearinghouses can contact UHIN for information on how to send electronic claim attachment transactions. If you are currently sending electronic medical bills to State Farm, then the connection to sending electronic claim attachments is the same.


Utah Health Information Network (UHIN)

Contact UHIN at 801-466-7705 ext 200 for connection information to send electronic claim attachments.

The State Farm UHIN Trading Partner number is: HT005054-001.