How are medical record requests handled for the Recovery Audit Contractors (RAC) related appeals/redeterminations?

It is important to note that providers are responsible for submitting records to the RAC in response to a complex review (a review that involves a full review of all medical records and billing information related to the claim involved) within the timeframe expressed by the demand letter. If records have not been provided to the RAC, as is case for an automated review (based upon data analysis), then it will be necessary for the provider to submit records to Palmetto GBA if an appeal is filed. It is vital that the provider submit records when appealing an automated review to avoid denial of the appeal/redetermination as not medically necessary. With the immediate implementation of these new procedures, provider concerns about 'duplicate' requests for records should be alleviated.

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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