Claim Attachments 1.0.0

Claim Attachments is an external API that allows clearinghouses to submit medical claim attachments. It supports two primary workflows:

Unsolicited Claim Attachment – This workflow allows providers to submit medical documentation to support the adjudication of the claim at the time of the claim submission. Availity then delivers the attachment to the health plan for further processing.
Solicited Claim Attachment – After the health plan receives a claim and begins the adjudication process, it may determine that additional information is needed to complete the adjudication. The health plan can, therefore, create the 277RFAI (Request For Additional Information) transaction. These requests are delivered to the provider's –New inbox in . The clearinghouse can respond to these requests through the API. Availity matches the solicited responses to the provider's inbox work queue requests and sends the attachments to the health plan. Upon receiving these solicited responses, Availity moves the solicited request to the provider's Sent work queue and waits for the health plan to respond.

Endpoints


	Path	Function
1	POST/medical-attachments/ma/external/rest/response	Use this endpoint to submit an attachment to a claim.
2	GET/medical-attachments/ma/external/rest/status/{requestId}	Use the request ID from your POST/response request to check the status of your attachment.

Parameters

1. POST/response:


POST/response request body
Object	Type	Definition
submitter	Object (Required)	Object providing identifying and contact information the organization or person who submitted the attachment. Refer to the Submitter table for fields and definitions.
subscriber	Object (Required)	Object providing identifying and contact information about the health plan subscriber. Refer to the Subscriber table for fields and definitions.
patient	Object (Required)	Object providing identifying and contact information about the patient. Refer to the Patient table for fields and definitions.
provider	Object (Required)	Object providing identifying and contact information about the provider. Refer to the Provider table for fields and definitions.
payer	Object (Required)	Object providing identifying and contact information about the payer. Refer to the Payer table for fields and definitions.
encounter	(Required)	Object providing information about the provision of services to the patient. Refer to the Encounter table for fields and definitions.
payloads	Array	Array containing objects with information about the attachment(s). Refer to the Payloads table for fields and definitions.
product	Object (Required)	Object containing information about the healthcare product. Refer to the Product table for fields and definitions.

2. GET/status/{requestId}


GET/status/{requestId} parameters
Object	Type	Definition
requestId	Integer (Required)	The request ID received after your initial POST/response request that you can use to check the status of your attachment.

Sample requests and responses

1. POST/response

Request:

curl --location --request POST 'https://qua.api.availity.com/availity/medical-attachments/ma/external/rest/response' \	
--header 'accept: application/json' \	
--header 'content-type: application/json' \	
--header 'authorization: Bearer <access token>' \	
--data-raw '{	
    "payer": {	
        "id": "68069"	
    },	
    "submitter": {	
        "id": "477823",	
        "state": "TX"	
    },	
    "product": {	
        "type": "CLAIM",	
        "category": "MEDICAL"	
    },	
    "patient": {	
        "lastName": "Ochoa",	
        "firstName": "Blanca",	
        "dateOfBirth": "2004-11-03",	
        "memberNumber": "524845471",	
        "accountNumber": "NXGMDX-1236885"	
    },	
    "subscriber": {	
        "lastName": "Ochoa",	
        "firstName": "Blanca",	
        "dateOfBirth": "2004-11-03",	
        "memberNumber": "524845471",	
        "accountNumber": "NXGMDX-1236885"	
    },	
    "provider": {	
	
        "lastName": "Nxgen MDX"	
    },	
    "encounter": {	
        "serviceTo": "2021-06-24",	
        "serviceFrom": "2021-06-24",	
        "requestNumber": "RN85363437337111"	
    },	
    "payloads": [	
        {	
            "contents": [	
                {	
                    "reasonCodes": [	
                        {	
                            "value": "76438-1",	
                            "codeType": "LOINC"	
                        }	
                    ],	
                    "filename": "test.pdf",	
                    "contentType": {	
                        "type": "application",	
                        "subtype": "pdf"	
                    },	
                    "data": "JVBERi0xLjQKJcOkw7zDtsOfCjIgMCBvYmoKPDwvTGVuZ3RoIDMgMCBSL0Zg+IF0KPj4Kc3RhcnR4cmVmCjEyNzg3CiUlRU9GCg=="	
                }	
            ]	
        }	
    ]	
}

Successful response:

{
  "id":3325491
}

You can use this ID to make a GET/status/{requestId} request to check the status of your attachment.

If your request is unsuccessful, you may receive a response like this:

{
    "parameterViolations": [
        {
            "constraintType": "PARAMETER",
            "path": "sendResponseExt.arg0.patient.lastName",
            "message": "Patient Last Name is required.",
            "value": ""
        }
    ]
}