Government payers also request information using standard forms to reflect patient consent, medical necessity of durable medical equipment, duration of drugs, etc. Also, payers look for information on supplies such as drugs and duration or supplies and their price. Payers also request information about contradictions on the claim, such as seemingly incorrect coding and information to substantiate claims, such as certification documents and assignment of benefits information. The method of requesting and receiving this information depends upon the relationship a payer has with the provider and their technological capabilities. Some providers are able to receive and respond to these requests electronically.
Payers also request and receive information from providers via the mail, fax, and telephone systems.
From the NUCC perspective, attachments serve many purposes. Payers may request additional information to determine medical necessity. Some attachments are required for contractual agreements or government mandates. Requests for information may also be made because of a dollar threshold on a patient's plan. Additional information may often be requested if there are concerns regarding possibly fraudulent claims.