Prior Authorization Attachment Unsolicited Scenario – A provider submits a request for prior authorization to a payer and knows in advance that additional information is needed to complete the approval, the provider may submit the Attachment without waiting for the request. The diagram below depicts the business flow of the examples on for an unsolicited Prior Authorization Attachment. Arrow #1 Prior Authorization Request from a provider to a payer using ASC X12N 278. Arrow #2 Provider submits additional information previously agreed to between payer and provider as an Attachment using ASC X12N 275.. () Figure 7: Example Prior Authorization (Unsolicited) – Referral Attachment Unsolicited Scenario – A provider submits a referral to another provider or a payer and knows in advance that additional information is needed, the provider may submit the Attachment without waiting for the request. The diagram depicts the business flow of the examples on for an unsolicited Referral Attachment. Arrow #1 Referral is submitted from a provider to another provider or payer using ASC X12N 278. Arrow #2 Provider submits additional information previously agreed to between payer and provider as an Attachment using ASC X12N 275. () Figure 8: Example - Referral Attachment (Unsolicited) Notification Attachment Unsolicited Scenario – A provider submits a notifiction to another provider along with additional information as needed. In the example a facility provider discharges a patient of a primary care provider, and forwards a notification to that effect. The diagram below depicts the business flow of the examples on for a Notification Attachment. Arrow #1 Attachment information from the facility provider to the Primary Care Provider using ASC X12N 275. Figure 9: Example - Notification Attachment (Unsolicited)
Prior Authorization Attachment – Unsolicited Scenario A provider submits a request for prior authorization to a payer and knows in advance that additional information is needed to complete the approval, the provider may submit the Attachment without waiting for the request. The diagram below depicts the business flow of the examples on for an unsolicited Prior Authorization Attachment. Arrow #1 Prior Authorization Request from a provider to a payer using ASC X12N 278. Arrow #2 Provider submits additional information previously agreed to between payer and provider as an Attachment using ASC X12N 275.. () Figure 7: Example – Prior Authorization (Unsolicited) Referral Attachment – Unsolicited Scenario A provider submits a referral to another provider or a payer and knows in advance that additional information is needed, the provider may submit the Attachment without waiting for the request. The diagram depicts the business flow of the examples on for an unsolicited Referral Attachment. Arrow #1 Referral is submitted from a provider to another provider or payer using ASC X12N 278. Arrow #2 Provider submits additional information previously agreed to between payer and provider as an Attachment using ASC X12N 275. () Figure 8: Example - Referral Attachment (Unsolicited) Notification Attachment – Unsolicited Scenario A provider submits a notifiction to another provider along with additional information as needed. In the example a facility provider discharges a patient of a primary care provider, and forwards a notification to that effect. The diagram below depicts the business flow of the examples on for a Notification Attachment. Arrow #1 Attachment information from the facility provider to the Primary Care Provider using ASC X12N 275. Figure 9: Example - Notification Attachment (Unsolicited)
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