Author Topic: Carrier Requests (Medical Records etc)  (Read 1091 times)

dfranklin

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Carrier Requests (Medical Records etc)
« on: January 29, 2010, 09:29:42 PM »
What does it mean when carrier requests:

1.  Complete Medical Records (Will Chart notes for DOS suffice?)  Does this mean ALL records or just for the DOS specified?  It says "Complete Medical Records 10/23/09-10/23/09...What exactly needs to be sent?

2.  Letter form of Medical Necessity (Will Chart notes for DOS suffice?) What exactly needs to be sent?

Thanks!

dfranklin

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Re: Carrier Requests (Medical Records etc)
« Reply #1 on: January 29, 2010, 09:52:03 PM »
Also, when it shows on an EOB more info needed do you have to call each time to find out what is needed? Or is it typically Medical Records/Chart notes?

What do you do if a carrier is always requesting notes for a patient? Do you just automatically request it from the provider and print the claim manually and send it in the 1st time (rather then send the claim electronically and wait for the carrier to request it)?

Thanks!

Don

Michele

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Re: Carrier Requests (Medical Records etc)
« Reply #2 on: January 30, 2010, 11:05:27 AM »
1.  Complete Medical Records (Will Chart notes for DOS suffice?)  Does this mean ALL records or just for the DOS specified?  It says "Complete Medical Records 10/23/09-10/23/09...What exactly needs to be sent?

If they don't specify dates, I send what is necessary for the services that the claim is for.  If they specify dates, I send all office notes for any visits in that date range.  When complete medical records are requested, I send office notes, and/or any test results for anything ordered pertaining to the services.

2.  Letter form of Medical Necessity (Will Chart notes for DOS suffice?) What exactly needs to be sent?

If they request a LOMN, the chart notes don't contain what they are looking for.  They want the provider to spell out why the services were needed. 
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Michele

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Re: Carrier Requests (Medical Records etc)
« Reply #3 on: January 30, 2010, 11:07:44 AM »
Also, when it shows on an EOB more info needed do you have to call each time to find out what is needed? Or is it typically Medical Records/Chart notes?

If it blankly states, "more info needed" then I would call.  They should spell out better on the eob what is needed.



What do you do if a carrier is always requesting notes for a patient? Do you just automatically request it from the provider and print the claim manually and send it in the 1st time (rather then send the claim electronically and wait for the carrier to request it)?

If they request notes every visit then I do manually print the claim and include the notes to cut down on time.



Michele
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