Author Topic: Request for Medical Records to pay another provider's claim?  (Read 1252 times)

mkk2009

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I received a request from BCBSFL for our medical records to pay another provider's claim. We referred the patient to have a sleep study. The sleep study provider sent BCBSFL their report and a copy of our written orders.
However, BCBSFL now wants all our records.

My question is, shouldn't this be treated as a regular records request with a fee for copying and a patient release? Why should we assume this additional cost when it is not included in our contract or to pay our claim?

 
If BCBSFL wanted our records to review our outstanding claim for payment, this wouldn't be an issue. Our claim was already paid. But now, they want us to copy our records to prove medical necessity or a pre-exisiting condition, in order to pay someone else's claim.

Is this happening to anyone else? I can see this opening the door to yet another reason to deny claims.

"We didn't receive the medical records from some other Doctor, so we couldn't pay your claim."

Any advice on how to respond?


Thank you! ???

PMRNC

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Re: Request for Medical Records to pay another provider's claim?
« Reply #1 on: July 02, 2009, 05:07:41 PM »
It's not unheard of.. remember that the reasoning is the patient's CARE which comes first.
Of course charge for the records as your state allows. What you don't want to do is compromise a patient's care by refusing to send the records and of course you want to make sure you have all the proper releases from the patient too.

 
Linda Walker
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