Launched in 2015 more than a decade ahead of the Health Care Claims Attachments Transactions and Electronic Signatures final rule (CMS 53-F) announcement, Cotiviti’s Electronic Claims Attachments solution is used in production by national payers and Blue CrossBlue Shield plans for both solicited and unsolicited attachment workflows.
Close the payer-provider data gap to reduce workflow ambiguity
Providers are constrained by legacy technology not aligned to modern interoperability standards, with no choice but to transmit unstructured information in outdated ways. Payers often bear the costs of rationalizing non-standard data. Cotiviti sees and supports the potential to improve payer-provider collaboration, while reducing or eliminating manual rework.
Stay ahead of evolving regulatory standards
Cotiviti has actively participated in industry workgroups focused on claims attachments modernization since 2014, and our experts lead the WEDI Attachments Workgroup as co-chair to support stakeholders in meeting compliance deadlines. Industry dialogue and feedback continue to shape development of our Electronic Claims Attachments solution.
Electronic Claims Attachments solution benefits and features
Our product supports the CMS 53-F mandate by supporting national HIPAA standards for electronic exchange of health care claims attachments.
- End-to-end CMS 53-F compliance support – receive, manage and track 275 and 277 RFAI claims attachment transactions
- Improved payer-provider workflow experience – creates a payer-sponsored digital channel that simplifies attachment exchange and enhances provider engagement
- Broader coverage than a clearinghouse – helps payers achieve broader attachment coverage across their provider network, including providers not already served through a single clearinghouse ecosystem
- Operational visibility – out-of-the-box visibility into solicited and unsolicited attachments within the Transaction Management interface, plus dashboards and tracking capabilities
- Support for structured clinical documents – Clinical Knowledge Pack (CKP) to view CCDA and HL7 content directly
- Foundation for broader interoperability workflows – establishes infrastructure to support future prior authorization and clinical information exchange initiatives
Cotiviti offers two solution packages:
Attachments Module supports compliance with CMS 53-F including ingestion and validation of X12N 275 submissions; generation and transmission of X12N 277 RFAI transactions; electronic signature validation; and processing of embedded CCDA clinical documents. An embedded provider-facing portal to support these functionalities is also available.
Attachments Plus Clinical Module includes everything with our base package as well as Cotiviti’s Clinical Knowledge Pack (CKP) to view CCDA and HL7 clinical documents directly in the Transaction Management interface.
