Attachments
Attachments serve as a way for PBM/payers to substantiate some prior authorization determinations and may be required in some instances. Surescripts strongly recommends that provider vendors support the ability to electronically send PDF attachments at a minimum. All implementations shall be able to send and receive a PDF file type per ACR PA.212 in the Application Certification RequirementsApplication Certification Requirements section.
Note: If the payer receives an attachment type they do not support, they must return an open PAResponse requesting the acceptable type.
NCPDP attachment types include:
- TIFF
- PNG
- JPEG
- CDA
- CCR
Only send an attachment if the question set specifically asks for it. If you do not receive a request for an attachment, do not send one. Sending unnecessary attachments may result in manual review and delays. Message size (including attachments) is limited to a maximum of 20MB.
If an attachment is required, Surescripts recommends informing the user of the requirement and displaying the Attachment Notes per ACR PA.201
If a PBM/payer receives an attachment type they do not support, it is recommended to return an open PAResponse requesting the acceptable type.
PBM/payers should populate the QuestionSet/Header/QuestionSetContactCommunicationNumber/Fax/Number field in ePA response messages so provider vendors know where to fax any requested attachments they are unable to send electronically.
If an attachment must be sent through fax, the fax should include the PACaseID from the PAInitiationResponse to aid in linking it to the electronic messages. The provider vendor should also include in the QuestionSetComment field of the PARequest that they are faxing documentation.