Providers
Attention, Providers:
Submit a 275 claim attachment transaction
First Choice VIP Care Plus 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 77009.
Availity
- There are two ways 275 claim attachments can be submitted:
- Batch — You may either connect to Availity directly or submit via your EDI clearing house.
- Portal — Individual providers may also register at:
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.
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)
First Choice VIP Care Plus is a Healthy Connections Prime Medicare-Medicaid Plan offered by Select Health of South Carolina. South Carolina is one of several states selected to design new approaches to coordinated care for people on both Medicare and Medicaid.
As a First Choice VIP Care Plus Medicare-Medicaid Plan 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, achieving the goals of this plan which are to:
- Improve health outcomes
- Delay the need for nursing facility care
- Reduce avoidable emergency department visits and hospital readmissions
- Increase access to home and community-based services
Our robust network is designed to provide our members with integrated care. You will find other committed providers like you in the directories below.
- Find a Provider
Search for a PCP, specialist, hospital, or other health care provider in our network. - Provider and Pharmacy Directory (PDF)
See a list of all of the pharmacies in our network.
Provider data contained within the online directory is updated daily Monday through Friday.
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 1-855-327-4980.
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 Plus.
Other quick resources
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.
Have questions?
Call Provider Services at 1-888-978-0862 (TTY/TDD 711), 8 a.m. to 8 p.m., 7 days a week.
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