Service line 03 - Claim attachments

Claim Automatic Attachments

The right document rides with the claim, or answers the request. Without a bot.

Payers want records at two moments: with the initial claim, when a payer policy says a document must accompany it, and after adjudication, when an additional documentation request (ADR) arrives as a denial. Both are handled manually in most shops - someone pulls the record, someone attaches it, someone resubmits. This line automates the Epic side of both: proactive attachments generated and transmitted with the claim, and reactive attachments generated from the ADR without a person retrieving the document.

The two are separate services. Most organizations need both; some already have one.

RPA boundary Everything here works without RPA. Where a payer only accepts records through a portal, the base assumption is that a person performs that upload. If you'd rather automate that last step, we bring in an RPA partner - it's an option, not a dependency, and it's never inside the warranty.

What we deliver

Proactive

Payer and document-type rules for attachment-required claims
Document management (EDM/Media) mapping
Attachment generation at claim production
275/PWK transmission through the clearinghouse
Validation and training

Reactive

ADR denial identification and routing
Auto-generation of the requested document from the denial
Resubmission workflow
Validation and training

Both

Full build documentation
Plain-English user guides
Weekly live training

How the engagement runs

Scoping confirms coverage before the fee is firm.

Discovery confirms payer and document-type coverage, clearinghouse attachment support, and how ADR denials are worked today. The pathology accession case is a known gap in Epic's document model and is stated as excluded in scoping when it applies.

Each service

Discovery

2 wks

Build

6 wks

Test

2 wks

Go-live support

3 wks

What we measure

Technical outcomes, at baseline and 90 days after go-live.

First-submission attachment rateShare of attachment-required claims sent with the attachment on first submission.

ADRs auto-answeredShare of ADR denials answered with an auto-generated document.

Days to resubmissionFrom ADR receipt to resubmission.

Pricing

ServiceFixed fee

Claim Attachments - ProactivePB or HB

$100,000

Claim Attachments - ReactivePB or HB

$100,000

Examples

Proactive + Reactive, one billing system

$185,000

Proactive + Reactive, PB and HB

$345,000

Each fee covers one billing system, one service area, one operational owner. Every line is a separate service; the second service in a contract is 15% off, the third and beyond 20%.

Modifiers

Two or more services in one contract: 15% off the second, 20% off the third and each additional, applied to the lower-priced services
Each additional service area, same operational owner: +15%
Each additional operational owner: +30%
Payers beyond five, where payer count drives build: flat per-payer add

Assumptions

One billing system, one service area, one operational owner per fee
One client analyst participates 1-2 hours per week for knowledge transfer; client resources do not perform build or testing
Production and a recent-clone environment available for the duration
Current configuration, test accounts, representative files, and SME access provided within 10 business days of start
Any clearing-vendor engagement required by scope is complete before start
Clearinghouse supports 275/PWK attachment transmission
Payer portal uploads are performed by client staff unless the RPA option is contracted

Warranty

One-year warranty on all in-scope deliverables, covering configuration degradation from Epic upgrades or defects within the original scope. Full build documentation, plain-English user guides, and recorded training delivered at go-live.

Book a scoping call

Scoping confirms payer coverage, clearinghouse support, and whether you need one service or both.