Attachments Submission Prior Auth (275x211) API V1 Getting Started

Attachments Submission v1 API

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NOTE

See Attachments in electronic data interchange and their use in our APIs.

The Prior Auth Attachments Submission API supports the X12 electronic data interchange (EDI) 275 patient information transaction.

Our 275X211 API enables providers to electronically submit supporting documentation for healthcare service review and prior authorization workflows. Supporting clinical documents are received through a JSON interface, transformed into appropriate attachment transaction, and forwarded for downstream processing, so it is more accessible to developers for integration into users’ applications. Unlike the claim-attachment (275X210) workflow, the 275X211 transaction supports authorization review scenarios where a claim has not yet been created.

The Attachments Submission Prior Authorization (275x211) API receives clinical documentation and prior authorization-supporting files, associates them to a healthcare service review or notification, and then the 275x211 API:

• Accepts clinical documentation and prior authorization-supporting files
• Associates the documentation with a prior authorization or attachment control number to a healthcare services review or notification

Attachments submission take two forms: Solicited and Unsolicited.

• For Unsolicited attachment, when it is known that a UMO requires specific information to process a prior authorization request, the provider may submit an unsolicited 275 to include that information.
• Solicited attachments submission usually are sent by providers to payers that request documentation for a prior authorization request.

File formats supported

Our Attachments solution supports the TIFF, JPEG, PDF, JPG, PNG, BMP, GIF, TIF, DOC, DOCX, RTF, TXT, XML, HTML, XLSX, XLS file formats.

Attachments process flow

1. Prior Authorization request is submitted (278 transaction or API equivalent).
2. Payer requests additional documentation or attachments may be sent proactively.
3. The attachment is linked to the prior authorization request using identifiers.

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NOTE

For examples, see API examples.

For more information, please 275 Attachments (Batch EDI) Companion Guide.

Submit a 275x211 JSON payload and associated file(s) for prior authorization attachments submission. Include sufficient claim information (claimInformation object) in the request to ensure the prior auth attachments submission goes to the right place. A submission for a Solicited Attachments transaction (attachments requested by the payer) contains more payer information.