An increase in the number of attachment types that can be handled electronically will eliminate one of the reasons claims are submitted on paper instead of electronically. That is, it will increase electronic submissions, meaning administrative savings. Not all cases can be handled the same way. For providers whose practice we are closely scrutinizing, we need the option to flexibly request additional information based on specific carrier needs. From a coverage or medical necessity review standpoint, the claim attachment is part of the medical record.
Medical records can be a claim attachment and are frequently acquired separately from the claim.
Generally, for pre-processing claim review, we only need information relating to the date of service in question. For post-processing utilization review and, perhaps, fraud investigation, it may be necessary to request records for an entire hospital stay or specific time period a patient resided in a nursing home. We request the entire medical record for situations relating to concurrent care, serial surgery, cosmetic surgery, team surgery, and specialized durable medical equipment. Currently, the NUCC and NUBC have the responsibility for approving the content of information contained in the standard health care claim. The same organization should have the responsibility for approving content of claims attachments as has the responsibility for approving content of information contained in the standard health care claim.