Claim attachments

When we require documentation to support a claim or additional activities in which medical documentation is needed, we send a request.

Attachments that we may request include:

• X-rays
• Chart notes
• Operative reports
• Laboratory reports
• Dental or medical records

• Certificates of medical necessity

Our primary method for requesting and receiving claims-related medical records is by adding a medical attachment request to the provider organization's Medical Attachments queue in Availity Essentials.

Notes:

• Please respond to requests using the same format in which they were received (e.g., Availity Essentials, fax or email).
• Do not submit attachments with claims unless indicated on our Clinical Edits by Code lists.
• Sending unsolicited attachments can delay the processing of your claim.
• Please submit coordination of benefit (COB) information as part of your standard American National Standards Institute (ANSI) 837 health care claim transaction. Do not submit other health plan payment information as an attachment.
• The member should only complete and submit an incident (accident) report if they receive a request.

With Availity’s Medical Attachments, you can:

• Respond quickly and easily to payer requests for supporting medical documentation
• Send medical documentation to the payer as needed, reducing paperwork and manual processes
• Manage your requests in the Manage Attachments queue, keeping all your requests organized in one place
• View and access submitted records in the Medical Attachments History queue, making it easy to track and reference previous submissions

Availity saves the medical attachment records that you submit in the Medical Attachments History queue. You can access the claim and/or standalone attachments request and view details about the file you attached on the Manage Requests page.

To submit supporting documents to a payer, your Availity administrator must first register for this functionality. To set up medical attachments, follow these steps:

Step 1: Access Medical Attachments setup

• In Availity Essentials, select one of the following options:
• Select Medical Attachments Setup under Multi-Payer Enrollments on the Enrollments Center page
• Select Provider Registration on the Attachments Dashboard page
• In the Claims & Payments menu, select Medical Attachments under Claims and then select the Setup tab
• Type Medical Attachments Setup in the search field at the top of Availity Essentials and select Medical Attachments Setup

Step 2: Select application

• On the Select Application page, select Medical Attachment Registration and click Next

Step 3: Provider Management

• On the Provider Management page, verify or select the organization in the Organization field for which you want to use to fulfill medical attachments requests
• Enter a valid NPI and/or tax ID in the Billing NPI(s) and/or Tax ID(s) field and click Add ID(s) to assign medical attachments access for the provider Note: To add multiple NPIs and/or tax IDs, separate them with spaces, semicolons, or by pressing Enter after each NPI and/or tax ID

Step 4: Assign User Access

• On the User Access page, select the check box next to the name of a user to assign access to medical attachments
• Click Save Note: To remove a user's access to medical attachments, deselect the check box next to the name of a user and click Save

Step 5: Review and Confirm

• Review your changes and confirm that you have completed the setup process
• Click Save

• Make sure to use a unique email address for each user to receive new medical attachments requests notifications
• Users must have a unique email address to receive notification of access changes
• An email is sent to the user and the Administrator or Administrator Assistant when a user's access to medical attachments has been added or removed
• To move through the fields and buttons, press TAB
• To disregard any changes and return to Availity Essentials Home page, select Cancel and then select Yes
• Please submit coordination of benefit (COB) information as part of your standard American National Standards Institute (ANSI) 837 health care claim transaction. Do not submit other health plan payment information as an attachment.