How do I add an attachment to a claim?

Attaching files to a claim in Claim.MD

To search for payers that allow attachments, first click on this link to access the payer's list. Once you're on the list page:

1. Type in "Attachments": In the search box at the top of the page, type "Attachments".
2. View Updated Results: After entering "Attachments," the list will automatically update, showing only those payers that accept attachments.

After creating or uploading a claim to a payer that accepts attachments, you’ll see an "Attach Documents" link at the top of the claim form in Claim.MD.

1. Click on the Attach Documents link. 
2. Click on Select A File.
3. Select the file from your local drive.
4. Close the Attach Document Window.
5. The link will now display the number of documents attached.
6. Be sure to select the appropriate Attachment Type.

Attaching Files from Third-Party Software

Attachments can be submitted using several different methods from outside software.

Option 1 - Web Portal

Supported payers have an 'Attach Documents' option at the top of the claim form. There are no filename requirements, but attachments must be uploaded in the PDF file format.

Option 2 - Automated Upload - X12/275

• Contact your software vendor to confirm if they support X12/275 attachments. 
• Claims must be uploaded with a unique attachment control # (ACN) in the 837 PWK segment prior to uploading an X12/275 file. 
• Claims will be held pending documentation if a PWK segment is received.

Option 3 - Automated Upload - PDF

• Contact your software vendor for assistance automating attachments. Claims must be uploaded with a unique Attachment Control Number (ACN) prior to uploading a PDF attachment. 
• Claims will be held pending documentation if an ACN is received.
• Required Attachment Filename Syntax: [attach_ACN/PWK06].pdf
  • Example: 123123.pdf

How to send an Attachment Control Number (ACN)?

• File Format ACN Location
• X12 Loop 2300, Segment PWK06
• XLS/CSV Add column 'attach_acn'.
• XML <claim attach_acn="nnnnnnnn">
• Print Image Custom mapping required. 

Open ticket from example claim.

• If you have questions or need assistance setting up automated electronic attachments please open a support ticket from within your Claim.MD account.

Medicare Part B - Unsolicited Attachment Criteria

Part B unsolicited criteria includes:

• Services submitted with the 22 or 66 modifier requires a clear concise statement and the operative notes.
• Services submitted with the 62 modifier and the procedure code has a multiple surgery indicator code of 1 require the operative notes.
• Claims submitted with procedure codes 21031, 21032, 21110, 30120, 30400, 30410, 30420, 30430, 30435, 30450, and 69300 require medical necessity documentation.
• Services submitted with AS, 80, 81 and 82 modifiers and the procedure code has an assistant surgery indicator of 0 require the operative notes.
• Claims submitted with greater than 5 surgeries on the date of service.
• Claim scenarios that require additional documentation, as identified by the provider's billing history.
• Surgical NOC procedure codes require an operative note when the procedure can't be adequately described in the comment field.
• Services submitted with the 53 modifier require an operative note when the procedure can't be adequately described in the comment field.
• Modifier GM requires documentation including the specifics of a multiple patient transport, must include the number of patients transported and their Medicare HICN/MBI.