October 27, 2006

In addition to paper and fax attachments, providers now have the ability to submit attachments electronically with their 837 Version 4010A1 electronic claim submissions through an approved third-party vendor. The following guidelines should be used for submitting electronic attachments:

Providers
To submit electronic attachments, providers must be authorized to bill 837 v.4010A1 electronic claims and enter into a business agreement with a third-party vendor that offers the ability to enter an Attachment Control Number (ACN) in the Paperwork (PWK) Segment of the 837 v.4010A1 electronic transactions. For a list of approved third-party vendors, providers may refer to the CMC Developers, Vendors and Billing Services Directory.

The approved third-party vendor will preprocess the attachments and send the images electronically to Medi-Cal on the provider’s behalf. Medi-Cal then links the electronic attachments to the corresponding electronic claim. The vendor preprocessing the claim attachment will supply the provider with the ACN for the electronic transaction.

Providers have a maximum of 30 calendar days from the claim submission date to include the supporting electronic attachments. For further information regarding attachment submissions, please refer to the Billing Instructions section of the 837 Version 4010A1 Health Care Claim Companion Guide.

Vendors
Vendors interested in providing electronic attachment processing services must be true “vendors” or “service providers,” which means they offer their services to the general public. Please review the Medi-Cal Electronic Attachment and Image Specifications (Third-Party Vendors) for details about transmitting electronic attachment images to Medi-Cal. The specifications document is available on the “ASC X12N Version 4010A1 Companion Guides and NCPDP Technical Specifications” page on the Medi-Cal Web site. Vendors who have reviewed the specifications and are ready to enter into a business agreement with EDS should call the Telephone Service Center (TSC) at 1-800-541-5555 (select option 16, then 11) to obtain a business agreement.