What are the differences between Solicited and Unsolicited Attachments?

The serviceLines JSON object contains the values that define the key difference in Solicited and Unsolicited attachment transactions. For any transaction, in JSON, the key values are:

For Unsolicited Attachments

The key JSON elements in Unsolicited attachment transactions are:

• providerAttachmentControlNumber

• payerAddress and its elements

You send Unsolicited attachments as part of the process of submitting 275 claim transactions which contain attachments as standard documentation for the claim. Worker's Compensation claims are a good example; with these claims, it's expected that attachments may be forwarded as part of the claim submission. You use the providerAttachmentControlNumber as the control number value in the serviceLines JSON object. An example:

  {
    "serviceLines": [{
      "providerAttachmentControlNumber": "123456789"
  }

Unsolicited transactions will contain the required payerAddress object, which has the payer's address information. It consists of the following:

  "tradingPartnerName":"Happy Payers of Washington State",
  "payerAddress": {
      "address1": "123 address1",
      "city": "city1",
      "state": "wa",
      "postalCode": "981010000"
    },

Use this address information in the request body when you need to mail the physical attachments to the payer. This may be necessary when the payer does not support either electronic attachment transactions or fax.

For Solicited Attachments:

The key JSON elements in Solicited attachment transactions are:

• payerClaimControlNumber

• tradingPartnerName

• payerAddress and its elements

You typically send Solicited attachments in response to a 277R transaction from a payer that requests additional documentation for a submitted claim.

When you edit the request body, ensure that you have the payerClaimControlNumber as a unique value for each attachment, as the subordinate field to the serviceLines JSON object.

    "serviceLines": [{
      "payerClaimControlNumber": "123456789",
    }

Solicited attachment transactions also contain the required payerAddress object, which has the payer's address information. It consists of the following:

  "tradingPartnerName":"Happy Payers of Washington State",
  "payerAddress": {
      "address1": "123 address1",
      "city": "city1",
      "state": "wa",
      "postalCode": "981010000"
    },

The tradingPartnerName is also required in the JSON request body.