Attachment Submission Prior Auth

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Submit a 275X211 JSON payload and associated file(s) for prior authorization attachment submission. The request field is a JSON string conforming to the RequestPriorAuth schema.

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IMPORTANT

Please note that the request requires you to provide all the required field values. These required values are GREYED out, which are pre-populated example values and can be selected to view the canned response. To view the required fields, expand the + symbol (indicated by the variables field below. For more information, please refer to the JSON-to-EDI API Contents section.

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CAUTION

Please do not submit PHI or PII data in the TryIt! interface (sandbox environment).

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.

Body Params
files
array of files
required

One or more attachment files to upload. Each file name must match the name in attachmentDetails.

string
required
Defaults to {"controlNumber":"123459998","purposeCode":"11","informationSource":{"entityIdentifierCode":"1P","lastName":"Smith","firstName":"John","npin":"1942788757","contactInformation":{"name":"Johnone Doeone","phoneNumber":"0000000000","phoneExtension":"101"},"providerSecondaryInformation":{"stateLicenseNumber":"SL123456"}},"informationReceiver":{"organizationName":"XYZ Insurance Company","planId":"PLAN12345","payerIdentification":"ATTP1","contactInformation":{"name":"Johnone Doeone","phoneNumber":"0000000000"},"providerSecondaryInformation":{"medicareProviderNumber":"MCARE12345"}},"patient":{"entityIdentifierCode":"IL","firstName":"Johnone","lastName":"Doeone","memberId":"0000000002","patientAccountNumber":"ACCT987654","patientEventTrackingNumber":"TRK2024001","contactInformation":{"name":"Johnone Doeone","phoneNumber":"0000000000"}},"serviceReviewInformation":{"serviceLines":[{"attachmentControlNumber":"ATT123456789","submissionDate":"20240414","diagnosisCode":"M54.5","procedureCode":"99213","procedureCodeQualifier":"FO","serviceTraceNumber":"SVC20240414001","statusInformation":{"statusCategoryCode":"A1","loincCode":"11488-4"},"attachmentDetails":{"name":"test_image.jpg","attachmentInformationFormatCode":"MB","binaryDataLength":"2048"}}]}}

JSON string conforming to the RequestPriorAuth schema. The default value below is a complete, ready-to-send example to make testing easier.

Headers
boolean
Defaults to false

When true, performs submitter validation lookup before processing.

Responses

Language
Credentials
Bearer
JWT
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Response
Click Try It! to start a request and see the response here! Or choose an example:
application/json