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Electronic claim attachments

Requirements for claim attachment submission are standardized across Minnesota. Minnesota Health Care Programs (MHCP) requires only a limited number of claim attachments. Claims with attachments are complex claims for prompt payment purposes.

When you need to submit an electronic claim with an attachment, follow these steps:

  1. Review the claim attachment criteria to ensure that your claim attachment is necessary.
  2. Complete the Administrative Uniform Committee (AUC) uniform Claims Attachment Cover Sheet which is required for all attachments in Minnesota. Download it from the Minnesota Department of Health’s AUC Forms webpage. Use the AUC uniform cover sheet only for electronic claims that require an attachment. Do not use the AUC uniform cover sheet without an attachment control number (ACN) or to submit authorization requests that require attachments.
  3. Create a unique ACN. The ACN must be unique to each claim and must not be the patient account number unless patient has new account number each visit.
  4. Enter the unique ACN (including spaces and hyphens) on each attachment page, the cover sheet and your electronic claim. Each type of attachment must have its own completed cover sheet. On the cover sheet, enter the ACN as follows:
    • Interactive: Enter the ACN(s) in the Claim Information tab, Attachment Control Number/PWK field; select the qualifier in the type field
    • Batch: Enter the ACN(s) in Loop 2300, PWK06; enter the attachment type in Loop 2300, PWK01; enter the method by which you send the attachment information in Loop 2300, PWK02 (follow complete AUC Attachment Cover Sheet Instructions (PDF))
  5. Submit the claim electronically via MN–ITS Interactive or Batch.
  6. Fax the cover sheet and attachments to MHCP at 651-431-7786.

Providers must send the attachment by the end of next business day after submitting the electronic claim. MHCP will deny claims that do not include an attachment.

Claim attachment criteria

Reason for attachment: MHCP will accept the attachments as noted in the following scenarios.  Please follow these criteria and attach only the additional documentation noted here.

Scenarios and required documentation

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