Medical Review Requests for Medical Records
When an Additional Development Request (ADR) is sent to a provider, the provider has 30 days in which to return the medical records to NHIC, Corp. The claim will deny if the records are not received by day 45. Denial code 56900 is appended to these claims indicating the denial occurred for lack of response to the ADR. Providers should aim to return their records in response to an ADR by day 30 in order to avoid denials for timeliness. 
When an ADR is generated, the claim will be found in status/location S B6001. After the records are received by NHIC, Corp., the claim will be moved into Status/location S M5REC. The claim will remain in this location until it is reviewed and processed.
Upon receipt, the medical records are scanned. When submitting hardcopy medical records, please consider the following suggestions:

• Please do not use staples or paperclips
• Each packet should be bound with a rubber band with the appropriate ADR on top and the correct medical records
• Please avoid mixing single and double-sided documents
• Return the medical record to the correct address listed on the ADR
• Please do not include any other correspondence or claims that do not pertain to your ADR
• Please do not send medical records until you receive an ADR

NHIC, Corp. accepts electronic medical records submitted by an appropriate Health Information Handler. More information on this can be found in the Electronic Submission of Medical Documentation (esMD) Pilot Projectarticle available on the NHIC, Corp. Web site athttp://www.medicarenhic.com/Part A (Education > Education Articles > 26 January 2012). 
Additional information on the ADR process can be found in the Additional Development Request billing guide available on the NHIC, Corp. Web site at http://www.medicarenhic.com/Part A (Billing Support > Billing Guides).

Connolly is tasked with auditing Region C, which consists of the states of:
AL, AR, CO, FL, GA, LA, MS, NC, NM, OK, SC, TN, TX, VA, WV and the territories of Puerto Rico and U.S. Virgin Islands which makes up 39% of the United States. Region C is the largest of the four RAC regions

Submitting medical records to Connolly is easy! Just follow these simple steps:
Direct Electronic Connection with HealthPort 
Connolly has partnered with HealthPort to create a secure point to point connection that will accept electronic transmissions of medical records from HealthPort responding to RAC complex reviews.
For more details on the Connolly/HealthPort connection, please contact HealthPort at 

1-800-737-2585 or visit their website www.healthport.com/esend

CD or DVD Records:

1. Scan a copy of Connolly’s medical record request letter.
2. Save the request along with all requested copies of medical records as a PDF or TIFF file (B&W only please) on a CD or DVD. Each medical record should be one file; please do not save individual pages as files.
3. Please also include an Excel file on the CD/DVD with the following information:

• Patient Information: Name (first and last); DOB (date of birth); Account/Control number; HIC number (Health Insurance Claim number/patient ID on the Medicare card); Medical record number
• Dates of Service: The date the patient’s service began and ended
• Provider Information: Name (full name), Provider Number and NPI (National Provider Identifier)
• Other Important Numbers: Requested claim number; Medical record number
• The number of pages or size of file of the image and the total number of medical records recorded on the CD/DVD.

1. The file name must match the Claim Number.
2. Send the CD or DVD to:

Attn: CD/DVD Submission
Connolly Healthcare
1 Crescent Drive Ste 300A
Philadelphia, PA 19112-1015

Please Note the Following:

• Encryption: We strongly recommend all images be encrypted with WinZip and password protected, with the password sent separately to: RACINFO@connolly.com. This email should include: Provider ID, Sent date (MM-DD-YY), and number of images. If PGP data encryption is used, public and private keys must be established prior to shipment.
• Sending: When sending CDs or DVDs, please put them in a tamper-proof package and name them according to this convention: <Provider ID>_<date sent in MM-DD-YYYY format>_<number of images> and please track them through the carrier you choose (FedEx, UPS, DHL, USPS registered).
• Acknowledgement of Receipt: Once Connolly receives the CD or DVD, it will be processed and an acknowledgement fax and/or email sent to you (the contact you have pre-designated in the Request for Contact information form. Connolly will provide the CD/DVD name, the date the disk was received, the date the disk was processed and its status (either accepted or rejected). Reasons for rejection include: CD/DVD’s with any encryption aside from WinZip or PGP, file count mismatch, page count mismatch, missing metadata file.

Diversified Collection Services, Inc. of Livermore , California , in Region A, initially working in Maine , New Hampshire , Vermont , Massachusetts , Rhode Island and New York .

DCS http://www.dcsrac.com/documentation.html
Provider Medical Record Submission Requirements

Record Requirements

• Please note that the additional documentation and medical records are due 45 days from the date of the additional documentation request letter. An extra 10 days will allowed for shipping time to insure that the providers have the full 45 days to assemble the medical records.
• Please be sure documentation submitted is legible
• Please submit required documentation and any additional documentation that supports the procedures/codes billed for all dates of services related to the claim.

Medical Record (MR) Submission Requirements (Paper/CDs or DVDs)
 
Paper Medical Records

• Include the original or copy of the additional documentation request letter (ADR) from the RAC.
• If possible, highlight claims on the letter identifying the medical record attached.

CDs or DVDs Medical Records:

• Scanned image resolution must be clear and legible. 300 dpi and in black and white is preferred, though images with less resolution will be accepted as long as the quality is sufficient for the medical review staff.
• Image format must be in either TIFF or PDF format though TIFF is preferred.
• One image per medical record, i.e., multiple-page image file. For example, a two hundred page medical record will be one file.
• The image file name must be “provider NPI-Claim number”. For example if the claim number 123456 is requested and the provider NPI was654321, the filename would be 654321-123456.pdf or 654321-123456.tiff

https://racb.cgi.com/default.aspx

CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan , Indiana and Minnesota

Medical Record Submission Instructions
Medicare’s CGI RAC Region B
Records are accepted in paper format and on CD or DVD. 
DUE DATE: 45 days from the date on the medical record request letter 
Paper Records 
Paper medical records must meet the following requirements: 
Free of staples and paperclips. 
Pages should be top faced, and face up. 
Photocopy must be of good quality and legible. 
Include a copy of the CGI RAC B Additional Documentation Request Letter (medical record request letter). 
Records must be copied on only one side. 

Imaged Records 
CGI RAC Region B encourages providers to submit medical records in imaged format via CD or DVD. Imaged medical records must meet the following requirements: 
Scanned image resolution must be 200 dpi and in black and white. 
Image must be in the TIFF, with Group 4 compression, or in PDF format. CGI would prefer the TIFF format. For the use of any other formats, please contact the CGI RAC Region B Call Center at 1-877-316-RACB (7222) prior to sending the files. 
For PDF format, DO NOT password protect the individual PDF files. Instead, zip all PDFs into a WinZip file and encrypt it, or use PGP encryption. 
Multipage documents must be in one image. For example, a 50 page medical record will be one image file. 
Scanned image must be legible. 
The image file naming convention must be as follows; <Patient Name>_<Admit Date/Date of Service>. For example, if the Patient Name is John Smith and the date of service is October 1, 2008, then the file will be named JohnSmith_10012008.tif. 
Include a copy of only the first page CGI RAC B Additional Documentation Request Letter (medical record request letter); you can include the first page on the CD/DVD, but please do not encrypt it; all Medical Records must be encrypted. 

Medical Record Submission 
Label the CD or DVD according to the following naming convention; <Provider Facility Name>_<medical record request letter date in YYYYMMDD format>. Example: MercyHospital_20091212. 
Please send all medical records, both paper and CD or DVD, in tamper proof packaging, such as security mailers, tamper evident mailers, or security labels. 

Encryption 
For security purposes, all images sent should be encrypted either in a WinZip file that is password protected, or by using PGP encryption. 
For encrypted WinZip files: Use your Additional Documentation Request Letter ID (medical record request letter) as the password. For Providers that use a version of WinZip that requires 8 characters to encrypt, please place zeros BEFORE the Letter ID; i.e. 00075231. 
For encrypted PGP files: Contact CGI RAC Region B prior to shipment to obtain the Public Encryption key. This can be accomplished by calling our CGI RAC Region B Call Center at 1-877-316-RACB (7222). 

Send medical records as follows: 
Medical records for Indiana, Illinois, Kentucky, Michigan and Ohio: 
CGI Federal Inc. 
Attn: RACB 
1001 Lakeside Ave., Suite 800 
Cleveland, OH 44114 
Medical records for Minnesota, Wisconsin, DME and Home Health: 
Attn: Medicare Recovery Audit Subcontractor - Region B 
PO BOX 742888 
Atlanta, GA 31139-9998

Medical Records Submission

• Label the CD or DVD according to the following naming convention for easy communication, tracking, and reconciling purposes: <Provider NPI>_<sent date in MM-DD-YYYY format>_<number of images>
• For security purposes it is recommended that all images sent should be encrypted or password protected.
  • A password will be provided in the medical records request letter
  • If medical images are encrypted using PGP, public and private keys to decrypted image files must be established prior to shipment

• We strongly suggest sending all medical records to DCS via trackable carriers (FedEx, UPS, DHL, registered USPS mail, etc.)
• Please send CD/DVD images in a tamper-proof package.
• Send all medical records to:

DCS Healthcare Services
2815 Southwest Blvd
San Angelo, TX 76904



HCI https://racinfo.healthdatainsights.com/Public1/ProviderInfo.aspx
HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana , Wyoming , North Dakota , South Dakota , Utah and Arizona .

How to submit records to HDI via CD/DVD: 
Please adhere to the following instructions when submitting a record via CD/DVD: 
Format: 
Attach a copy of the pull list in front of the imaged record with the corresponding patient name circled 

Scanned image resolution must be between 200-300 dpi and in black and white 

Scanned image must be legible 

File must be in a PDF or TIFF with Group 4 compression format (PDF preferred) 
Each image file naming convention must include the reference number listed on the HDI pull list. If another document for the same reference number has been shipped before, an extension code is required to provide uniqueness between files. 

Example: First time sending: 000ABC.pdf or 000ABC_1.pdf Second time sending: 000ABC_2.pdf 
• The following metadata (excel file or tab delimited text file) must be included with the image submission: 
- Requested Reference Number (located on HDI pull list) 
- Requested Claim Number (located on HDI pull list) 
- Begin Date of Service 
- End Date of Service 
- Patient name (first and last name) 
- Patient DOB 
- Patient HIC Number 
- Patient Account/Control Number 
- Medical record number 
- Provider Name (full name) 
- Provider Number 
- Provider NPI 
- Number of pages or the file size of the image submitted 
- Total number of medical records on the CD/DVD 
There should be one entry per image in the metadata file. 
Submission: 
Multiple charts can be sent on one CD/DVD but each chart request (reference #) must be a separate PDF/TIFF file. 
CD/DVD should be labeled as <Provider Facility name>_<Medical record request letter date: MMDDYYYY>_<Number of images on CD/DVD> 
Example: Hospital_01012010_4 
If CD/DVD contains records from multiple medical record request letters, please use the range of dates from the medical record request letters in the CD/DVD naming convention. 
Example: Hospital_01012010-02012010_4 
CD/DVDs do not require encryption but it is recommended for security purposes. If encryption/password protection is desired, the following common WinZip options are accepted: 
Zip 2.0 compatible encryption 

256-Bit AES encryption 

PGP Encryption 

If a password is required to open a zipped CD/DVD please submit that password to HDI, prior to shipment, via one of the methods below. Please provide a record identification reference (reference number/claim number/audit number) for identification. 
• FAX password to 702-240-5595 • 

E-mail password to racinfo@emailhdi.com • 

Call (866) 590-5598 and provide password to a Provider Service Representative NOTE – Do not leave the password on the HDI voice mail If PGP encryption is used, public and private keys to decrypt images must be established with HDI prior to shipment. 
All medical documentation mailed to HDI via paper or CD/DVD should be sent in tamper-evident packaging such as security mailers or tamper sticker labels.

Physical Return Method

• Physical requirements
  • Include the original or copy of the additional documentation request letter (ADR) from the RAC
  • Highlight claims on the letter identifying the medical record attached
  • No staples
  • No paperclips
  • Top faced
  • Single sided
  • Double sided
• Mailing Requirments
  • Tamper proof package
  • Carrier
  • Tracking number
  • Naming format
  • Address format

Electronic Return Method

• Image requirements
  • Resolution
  • File size
  • Images per medical record
  • Naming format (eg. Filename must match claim number, “Provider NPI-Claim number.tiff”, <Patient Name>_<Admit Date/Date of Service>.pdf)
  • B&W
  • Color
  • File format
    • PDF
    • TIFF
  • Compression
• Media Requirements
  • CD
  • DVD
  • Labeling requirements (eg <Provider NPI>_<sent date in MM-DD-YYYY format>_<number of images>)
• Required metadata
  • Physical Return Method
  • Elements
  • Format (eg Excel, tab delimited)
• Encryption requirements
  • WinZip
  • Password protected
  • Password sent separately to email@example.com
  • Additional email requirements (eg Provider ID, Sent Date, number of images, reference number/claim number/audit number)
  • Password submitted via phone call
    • Phone number
    • Time
  • PGP key requirements