As a reminder, when you receive a request for medical records, it’s important to comply within the allowed timeframe. In alignment with industry standards, we apply technical denials to claims selected for audit when we don’t receive the requested medical records.
Technical denials: definition, timeline, outcome
A technical denial is an administrative claim denial issued when a provider doesn’t respond to requests for medical records.
When a paid claim is identified as requiring medical record review, providers receive three requests to submit medical records. These letters include a list of the requested medical records and instructions for submission and state the claim will be denied if they don’t submit the requested records within the timeframes specified in the letters.
If the medical records aren’t submitted by the deadline, we deny the paid claim to provider liability and take back the paid funds. The claim may show a denial code which indicates additional documents are required.
After a technical denial
Even after a technical denial is issued, you can submit the requested medical records to the requestor for consideration.
For funds recoupment, follow our corrections to overpayments process, or we’ll recoup from future claims payments.