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Supporting info and links

Documents the payer may ask for. Optional.

Supporting information (2)

Optional. Attach clinical documents and codes.
When the document was created

Choose a file

PDF, JPG or PNG, up to 10 MB each, 5 files at most. Provide either a file or a URL, not both.

Choose file
Category Attachment Title Size Creation Date
Attachment Knee-xray-28 Sep 2026.pdfImaging report 2.4 MB 28 Sep 2026 Remove
Attachment Orthopedic-report.pdfSpecialist letter 640 KB 05 Oct 2026 Remove

Accident details

Optional. Complete it if the request relates to an accident.

Related claims

Claim Reference Relationship Type Reference Identifier (Optional) Status
Claim_9e61b4d7 Associated Claim Approved
Claim_5b2c7e10 Prior Claim Expired

Link this request to prior authorizations or previous claims. Format: Claim_[response id], a claim that NPHIES accepted (a rejected one cannot be linked). Relationship types: Prior Claim, Associated Claim, Authorization to Extend, Appealing.

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