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Liability — When Medical Records are Requested
To properly conduct a beneficiary requested redetermination, it is often necessary to request medical records from the provider. In this situation, a letter requesting medical record documentation will be sent to the provider.
The medical records must be returned to the Appeals department within fifteen days from the request date. If not received, an Appeals Specialist will follow up with your facility. The information can be mailed or faxed. Go to the Contact Us page, select “Write Us” to obtain the Appeals address and fax number.
If the information is not received, the service(s) will be denied, and the liability of the claim will be placed on the provider. The provider would be required to refund any monies collected from the beneficiary for the noncovered services.
Page last updated: May 5, 2008
