Do not submit attachments with claims unless indicated on our clinical edits by code lists. If medical records are needed to process your claim, we will send you a request.
Our primary method for requesting and receiving claims-related medical records is through Availity's attachment application. Submit the requested records using an easy upload process that will save your office staff hours scanning, printing and mailing—and you’ll receive faster claims processing. You can also view the status and history of submitted records in the attachments dashboard and can message us directly from the application if you have questions.
Getting set up for the Availity attachments application is easy. Your organization’s Availity administrator can assign the Medical Attachments role to users who need access to Attachments – New. Follow the instructions in the Availity Essentials Attachments Tools – Getting Started Guide (PDF).
Attachments that we may request include:
- Chart notes
- Operative reports
- Laboratory reports
- Dental or medical records (View the information below about submitting medical records on Availity Essentials.)
Certificates of medical necessity
- Please respond to requests using the same format in which they were received (e.g., Availity Essentials, fax or email).
- 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.