Provider

Attention, Providers:

Restoration of Optum/Change Healthcare Connectivity (PDF)

Submit a 275 claim attachment transaction

First Choice VIP Care is accepting ANSI 5010 ASC X12 275 unsolicited claim attachment transactions. The 275 attachments are accepted via Optum/Change Healthcare and Availity. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 claim attachment transaction submissions via payer ID 88232.

Availity

After logging in, providers registered with Availity may access the Attachments - Training Demo for detailed instructions on the submission process via: Training Link [apps.availity.com] or refer to the Availity Claims Attachment Quick Reference guide located under Claims Resources at the bottom of this page.

Optum/Change Healthcare

  • There are two ways 275 claim attachments can be submitted:
    • Batch — You may either connect to Optum/Change Healthcare directly or submit via your EDI clearing house.
    • API (via JSON) — You may submit an attachment for a single claim.

View the Optum Change Healthcare 275 claim attachment transaction video for detailed instructions on this process.

General guidelines

  • A maximum of 10 claim attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100MB.
  • The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, doc, and txt.
  • The 275 claim attachments must be submitted prior to the 837. After successfully submitting a 275 claim attachment, an Attachment Control Number will generate. The Attachment Control Number must be submitted in the 837 transactions as follows:
  • CMS 1500
    • Field Number 19
    • Loop 2300
    • PWK segment
  • UB-04
    • Field Number 80
    • Loop 2300
    • PWK01 segment

In addition to the Attachment Control Number, the following 275 claim attachment report codes must be reported in field 19 of the CMS 1500 or field number 80 of the UB-04.

Attachment Type

Claim assignment attachment report code

Itemized Bill

03

Medical Records for HAC review

M1

Single Case Agreement (SCA)/LOA

04

Advanced Beneficiary Notice (ABN)

05

Consent Form

CK

Manufacturer Suggested Retail Price /Invoice

06

Electric Breast Pump Request Form

07

CME Checklist consent forms (Child Medical Eval)

08

EOBs — for 275 attachments should only be used for non-covered or exhausted benefit letter

EB

Certification of the Decision to Terminate Pregnancy

CT

Ambulance Trip Notes/Run Sheet

AM

Coronavirus (COVID-19)

Important information for providers regarding COVID-19.

Select Health of South Carolina is pleased to welcome our First Choice VIP Care participating providers. As a First Choice VIP Care provider, you are a part of a dedicated network that is ready to meet our members' health care needs. As partners in care, we'll work with you to ensure that our members receive access to the quality health care they need and deserve, through a plan which features:

  • A coordinated care approach.
  • Leading technology solutions.
  • Innovative community outreach programs that offer better health outcomes to our members.

Our robust network is designed to provide our members with integrated care. You will find other committed providers like you in the directories below:

If you notice any errors in the directory, please fax, on practice letterhead, the information as it should appear, to the attention of Provider Services at 1-888-978-0151, Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31.

Want to join our network?

We're always looking for providers to join our network of care. Learn about joining our provider network today. Check out credentialing information for First Choice VIP Care.

Please refer to the other provider links for additional information and resources. Check back often, as we continue to add and update provider materials, resources, trainings, and communications. If you have any additional questions, call First Choice VIP Care Provider Services at 1-888-978-0151, Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31.

Providers