Attachments Submission FAQs

📘

NOTE

For examples, see API Examples.

What does a typical Attachments API request look like?

The API uses a POST request. You provide the input as JSON in the body of the request. For the contents of an Unsolicited attachments submission request body example, see Attachments Request and Response from Payer.

What does a typical Attachments response from the payer look like?

After the clearinghouse sends the attachments and receives the payer acknowledgement, you will receive a response body showing the status of the attachments submission. Results may vary based on payer acceptance or non-acceptance of individual attachment files. See example in Attachments Request and Response from Payer.

For a longer set of response examples, see the topic Other Kinds of Responses in submissions.

What is the difference between Solicited and Unsolicited Attachment?

The serviceLines JSON object contains the values that define the key difference in Solicited and Unsolicited attachment transactions. For any transaction, in JSON, the key values are:

Unsolicited Attachments

The key JSON elements in Unsolicited attachment transactions are:

• providerAttachmentControlNumber

• payerAddress and its elements

You send Unsolicited attachments as part of the process of submitting 275 claim transactions, which contain attachments as standard documentation for the claim. The Worker's Compensation claim is a good example; with this claim, it is expected that attachments may be forwarded as a part of the claim submission. See example in Unsolicited Attachments for a 275 Claim Transaction.

Solicited Attachments

The key JSON elements in Solicited attachment transactions are:

• payerClaimControlNumber

• tradingPartnerName

• payerAddress and its elements

You typically send Solicited attachments in response to a 277R transaction from a payer that requests additional documentation for a submitted claim.

Solicited attachment transactions also contain the optional payerAddress object, which has the payer's address information. See examples in Solicited Attachment Response to a 277R Transaction and Solicited Attachments Transaction. The tradingPartnerName is also required in the JSON request body.

How do I query for a specific Attachments transaction?

The Attachments Status API uses GET and POST requests depending on the endpoint used. See example in Query Specific Attachments Transaction.

Use the trace Id value in your query path

The traceId specifies the attachment transaction in your query path. It supports the most accurate queries. It requires use of the traceId values that the Optum system applies to each attachment transaction.

The traceId is a unique 128-bit UUID value (as an example, 3ba21288-3f65-11eb-a512-6ab12069ade5) that Optum returns to the submitter as an acknowledgement when they receive every new attachments transaction.

📘

NOTE

The customer's back office developers should maintain the traceId value for every attachments submission record. Whenever a Status query references that value, it should be passed to Admissions Status.

See example in Use TraceId in your Query Path.

Use the fieldset argument in your query

Use the fieldset= value in combination with the traceId to form your query. It defines how much information you want to receive in response to your request. fieldset= uses either of two values to show the following:

• Use fieldset=summary for a brief summary of the submission;
• The fieldset=detailed option shows a more detailed description of the submission.

See example in Use Fieldset Argument in your Query.

What does a successful Attachments transaction response look like?

See example in Successful Attachments Transaction Response.

How can I check the status of a submission?

Our APIs do not support push notifications from the clearinghouse or the payer, API users will need to check on the status of attachment transactions that they have sent on behalf of the provider. See example in Check Attachments Submission Status.

A provider has two different teams; one enters the claim and the other verifies and submits it. Before submitting, can they enter the claim, save it, and have it released when ready?

Our APIs do not have a cache/drafting feature. Customers can develop and automate this feature. Customers should hold the claims on their end and programmatically set up a console to separate working on claims from submitting them.

Fax Numbers and the Attachments Submission API

A tradingPartnerServiceId can be used to send a fax to the payer by setting payerFaxNumber on the request.

A tradingPartnerServiceId can be used to send a physical mail packet to the payer by setting the payerAddress on the request.

See example in Send Fax Numbers to Payer.

What are the JSON-to-EDI mappings for the Attachments Submission request?

See example in Attachments JSON-to-EDI Map in a Request for a direct relationship between JSON fields in an attachment request and the X12 EDI loop associated with each field in the 275 request.

How do I attach multiple files in one transaction?

The attachments submission take two forms: Solicited and Unsolicited. See examples in Attach Multiple Files to a Transaction.

How do I use the API to send a fax to the payer?

The payerFaxNumber field is the payer fax number that you can use to send a digital fax to the payer. If payerFaxNumber is present and the trading partner is not set up for 275 transactions, a fax will be sent due to your request. See example in Send Fax Numbers to Payer.

How do I handle payer submissions when they don't support 275 transactions and don't accept faxes?

See example in Payer Submissions with unsupported 275 Transactions and that do not accept Faxes for instructions.

What file format types does the Attachments Submission API support?

See examples in Batch File Formats Supported and File Types Supported.

What do the statusCode Attributes mean?

Our Attachments Status APIs support a series of standard responses, called statusCodes to show various results from submitted attachment transactions. See also statusCode and statusMessage fields. You can use the Attachments Status sandbox environment to exercise attachment API calls and view these results in a safe environment. Doing so helps you get a clear view of how the attachments system works, so you fully understand how to submit documents associated with any medical claim.

📘

NOTE

See Handling Errors in Attachments Submission Transactions for more information about error remediation.

Using our sandbox examples provides the advantage of knowing in advance what can go wrong. Our goal is to enable the sender to solve any issue; and, even better, to avoid issues in the first place.

How do I remediate attachment transaction issues?

See examples in Remediate Attachment Transaction Issues.

Attachment Formatting

See attachment formatting section in Remediate Attachment Transaction Issues.

File Sizes

See file sizes section in Remediate Attachment Transaction Issues.

Search Does Not Turn Up a Record

Even when you correctly construct your search, you might receive empty array result, see example When search Does not Show a Record.

Rejections when a file is known good

See example in Rejections with Known Good File.

Fax and Mail Issues

See fax and mail issues section in Remediate Attachment Transaction Issues.

Does the Claim Submission or Claim Status APIs return Customer Account number from the insurance record?

It will have the memberID for the patient, not the account number from the billing system.

I am new to your company and health-tech in general. My provider is in network with Aetna and would like to submit claims using your APIs. When I try to enroll a payer in ConnectCenter, I find many different payer names with the word Aetna in it.

Which payer should I select? I want to use Optum APIs for Eligibility, Claims, Claim Status, and ERA. For example, most payers require enrollment to get ERAs through ConnectCenter. In this case, if our provider is in-network with Aetna, which of the above Aetnas I enroll with?

The best way to know which payer to submit claims to, look at the back of the insurance card. That ID should correlate to the Payer ID field.
If you do not have any other identifiable information for Aetna such as, if it is a part of a Better Health plan or an address, use the AETNA/60054 payer IDs.

Where can we get the adjudication message after submitting a claim?

See example in Get Adjudication Message after Submitting a Claim.

Is there a list of all the rejection code for validation when submitting claims?

We have a basic list of AAA error codes and possible resolutions available. Additionally, a list of claim status response codes that are maintained by the X12 organization can be found X12.org. Lastly, we have a list of Optum edits available in ConnectCenter under the Payer Tools >> edit search tab. Based on the edit message being returned the information may be entered in the incorrect location as the information should be specific to the patient.

Can we submit multiple claims at once, in batches?

We offer batch submissions through SFTP only, our current API does not allow for batch submissions. These should be 5010-compliant EDI files. Please reach out to your sales representative to discuss pricing options for SFTP submissions. Here is the available Claims responses and reports that lists the available reports.

Batch 275 submissions FAQs

Please see Batch 275 submissions FAQs.

Related Topics

• API Reference
• Troubleshoot APIs with Metadata