Updated January 12, 2006

Providers now have the ability to submit fax and electronic attachments with 837 v.4010A1 electronic claim submissions. This new functionality allows providers to submit electronic claims and fax their attachments, or send the attachments electronically through an approved third-party vendor. However, there are no third-party vendors available for electronic attachment submissions in the ASC X12N 837 v.4010A1 claim format. The approved list of third-party vendors available for electronic attachment submissions will be announced in a future Medi-Cal Update.

To utilize this new process, providers must be authorized to bill 837 v.4010A1 electronic claims. The fax process includes an Attachment Control Form (ACF), which is used as a coversheet for the supporting fax attachments. The ACF has a pre-printed Attachment Control Number (ACN), which submitters input on their electronic claim submission in the PWK segment. Providers submit the electronic claim and fax the ACF along with the attachments to Medi-Cal. Each ACF and corresponding attachments require a separate fax call. Each call to the fax server must include one ACF as the first page followed by the attachment pages that correspond to that ACF. Additional ACFs and attachments must be sent as separate calls to the fax server. The phone number to fax attachments is 1-866-438-9377.

The electronic process includes involvement with an approved third-party vendor, which preprocesses the attachments and sends the images electronically on the provider's behalf. Medi-Cal then links the faxed or electronic attachments to the appropriate electronic claim.

Providers have a maximum of 30 calendar days from the date of claim submission to submit the supporting faxed or electronic attachments. For further information regarding attachment submissions, please refer to the Billing Instructions section of the 837 Version 4010A1 Health Care Claim Companion Guide.