When and How to Send Claim Attachments in Healthcare EDI
Submitting a healthcare claim is a standard part of requesting reimbursement from an insurance company or payer. Whether you’re submitting a professional (837P), dental (837D), or institutional (837I) claim, the goal is simple: get paid for the care you’ve delivered. But sometimes, the claim alone isn’t enough.
Why Claim Attachments Matter
Certain medical and dental procedures require additional documentation before a payer will process the claim. These claim attachments help verify that a service was performed or medically necessary. They might include:
- X-rays
- Treatment plans
- Itemized bills
The specific attachment requirements vary by payer and service type. If the necessary documentation isn’t provided, the payer may delay or outright deny the claim.
Solicited vs. Unsolicited Attachments
Claim attachments come in two forms:
- Solicited attachments: Sent in response to a payer’s request for more documentation.
- Unsolicited attachments: Sent proactively because you anticipate the payer will need them, even if they haven’t requested them yet.
Payer Support for Attachments
Support for EDI-based claim attachments varies by payer:
- Some payers require transaction enrollment before they can receive 275 transactions.
- Others do not accept EDI attachments at all and may request documents via fax, email, or other offline methods.
Sending the right claim attachment at the right time can significantly reduce payment delays and denials. Using various APIs and EDI platforms, you can manage unsolicited attachments efficiently, ensuring your claims are supported and processed faster.
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