This is especially true of the self-insured plans and managed care plans. Automation and standardization would allow providers and third party vendors to develop data elements within their internal systems. This is not feasible at the current time due to the wide variety of requests. As a rule clinical information relates to the patient's care and is generally a part of the medical record. Claims information may include patient and subscriber demographic information, charge information, assignments, and conditions of admissions, etc.
Attachments are generally external forms which the payer requires.
In Kentucky the exception to this is for Medicaid and Blue Cross of Kentucky where Medicare is primary and crosses the claims over to either Kentucky Medicaid or Blue Cross of Kentucky. This requirement should cease altogether when payers forward claims to the next payer. Copy of any denial from the primary payer for the secondary payer. Kentucky Medicaid requires documentation of original claim filed if a claim is being refiled more than one year after the date of service. A copy of the Medicaid EOB must accompany the claim.