Attachment Workflow and Best Practice

Submitting attachments has two significant use cases:

• Unsolicited – Voluntarily sent by the provider without a request by the payer.
• Solicited – Sent in response to a request by the payer for more information about a medical claim.

These submissions are sent independently, however 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. Additional documentation on how specific payers associate attachment submissions with the correct medical claim can be found here.

Some payers will be configured for only unsolicited or solicited attachments, while some can handle both.

Some payers support the electronic submission of medical documentation attachments, while some support only fax and mailing of attachments or even limit submissions to mail only. Optum only handles Electronic Medical Attachment found on the Attachment payer list.

Best Practice

Refer to these topics for information about variability in Payer requirements and much more:

• Attachments Submission FAQs
• Attachments Status FAQs
• Attachments Retrieval FAQs

The source of truth for the supported payers can be found Trading Partners (Payer List) and Attachments Support. This list would have to reviewed manually however when payers are added or removed we will send out additional documentation via the email.