Clinical type documents are part of the medical record. These include the Sterilization Consent Form, Hysterectomy Consent Form, and ER reports. The Federal Black Lung program requires medical records be attached to the claim. This program does not accept electronic claims at this time. Other requests vary by payer.
Some payers automatically request medical records if the claim exceeds a preset dollar figure.
Other payers are suspected of using these requests as a tactic to slow the payment process. Yes, without a doubt. Some payers ask questions of the patient or subscriber for which the answers should already be in their data base. Standard rules need to be created and federal law changed to make all payers follow those rules. Payers should be forced to modify their internal systems rather than forcing every provider to provide information which payers should already have.