Associating Attachment Submissions to a Claim
All attachment submissions must be associated with a Professional (837p) claim or an Institutional (837i) claim. All payers have this requirement; however, each payer's process is different. In this section, we describe how specific payers associate attachment submissions with the correct medical claim.
Use Case: L.A. Care
The Attachment Control Number (ACN) is a key piece of information for all claims requiring attachments. It uniquely associates a claim with all attachments sent by providers and other submitters. It also works for Professional Claims or Institutional Claims. First, we will use a Professional Claims as an example.
As a medical payer, L.A. Care uses the EDI Loop 2300, using a couple of different EDI segments: the Claim Note (NTE) and the Paperwork (PWK) segment. These two segments apply to Professional Claims (we will describe Institutional Claims usage in the next section).
Claim Notes Segment
For transactions with L.A. Care, submitters must use the claimNote object and its additionalInformation field to add the phrase "Claim Attachment Submitted". Consult the mapping guide and the 837p X12 standards documentation for more details on this segment:
| Name | Element | Loop | Description | C/R |
|---|---|---|---|---|
claimNote (Object) | Claim Notes/Claim Information. | S | ||
additionalInformation | NTE02 | 2300 | Description to clarify the related data elements and contents. NTE01=ADD | 1/80 R |
For attachment purposes, L.A. Care requires the additionalInformation field. It is also a Required attribute from the 837p Implementation Guide.
Paperwork (PWK) Segment
In the claim, L.A. Care uses the Claim Supplemental Information (PWK) segment to describe each attachment for the current transaction. Each individual attachment document receives its own PWK segment, so a claim will have multiple instances of this segment when multiple attachments get submitted.
Here is the relevant part of the PWK segment as described in our Professional Claims JSON-to-EDI Mapping documentation:
| Name | Element | Loop | Description | C/R |
|---|---|---|---|---|
claimSupplementalInformation (Object) | S | |||
claimNumber | REF02 | 2300 | Claim ID number for clearing houses. REF01=D9 | 1/50 R |
reportInformation (Object) | ||||
attachmentReportTypeCode | PWK01 | 2300 | Code that describes the attachment contents. Ex: 08 = Plan of Treatment | 2/2 R |
attachmentTransmissionCode | PWK02 | 2300 | Code that describes how the attachment is sent. Example: BM = By mail | 1/2 R |
attachmentControlNumber | **PWK06 | 2300 | Identifies an electronic attachment. The ACN appears in the TRN02 field for an attachment. | 2/80 S |
NOTE
For your reference, the Attachment Submission 275 transaction contains the ACN. It is submitted in Loop 2000A, element TRN02, denoted as the field
providerAttachmentControlNumberin the JSON request body.
The PWK segment uses the claimNumber field to contain the Claim ID for immediate reference. Following it is the reportInformation object. It defines the attachment information for the claim:
| Field | Description |
|---|---|
attachmentReportTypeCode (required) | Uses a two-digit alphanumeric code to describe the title or essential category for the document, such as 'Treatment Diagnosis' (05). They are called Report Type codes, and can be found on Page 185 of the ASC X12 Consolidated 837p Guide. |
attachmentTransmissionCode (required) | Defines how the attachment is submitted as part of the claim. |
attachmentControlNumber | Appears in the PWK segment. It is the value associated with the specific attachment . This field only applies when the attachment is transmitted electronically. |
NOTE
Each electronically submitted document in the claim will have its own Attachment Control Number.
Updated 7 months ago