Supporting info and links
Clinical notes, files and the requests this claim depends on. All optional.
Supporting information (3)
Additional clinical documentation (optional). Each category asks for its own Code, Date, Value or Reason.
Attachment
Drop a file here, orChoose filePDF or image. Up to 10 MB each, 50 MB in total. Add an Attachment Title and a Creation Date.
Accident information
Complete if this claim is accident-related (optional).
Related claims (2)
Link to prior authorizations or associated claims (optional). Relationship Type is Prior Claim, Associated Claim, Authorization to Extend or Appealing. Links always use the NPHIES response ID in the format Claim_[id], never the portal request number, and a denied claim cannot be linked.