Provider Additional Documentation Submission Requirements

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

Record Requirements

If you would like to download a copy of the CDs or DVDs instructions please click here.

• Please note that the additional documentation and medical records for Prepay audits are due within 30 days, Post pay audits are due within 45 days from the date of the additional documentation request letter.

• Please be sure all documentation submitted is legible.

• Please submit only requested documentation as identified in the letter and documentation that specifically supports the procedures/codes billed for all dates of services related to the claim. If not requested please omit before sending.

All Blank pages should be OMITTED (Note: Provider will not be paid for blank pages)

• The metadata excel file must be included with each submission

- Requested claim number

- 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 for

    acknowledgement purposes
 

CDs or DVDs Medical Records:

  • Scanned image resolution must be clear and legible. 300 dpi and in black and white.
  • Image format must be in either PDF or TIFF format though PDF is preferred

o For PDF format, DO NOT password protect the individual PDF files. Instead, zip all PDFs into a WinZip file and encrypt it.

o 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 Performant Recovery , Prior to shipment, via one of the methods below. Must include a record identification reference (reference number/claim number/audit number) for identification.
    1. Call (866) 201-0580 and provide password to a Provider Service Representative
    2. E-mail password to info@PerformantRac.com

NOTE – Do not leave the password on the Performant Recovery voice mail

  • If medical images are encrypted using PGP, public and private keys to decrypted image files must be established prior to shipment, using one of the above methods.
  • One image per medical record, i.e., multiple-page image file. For example, a two hundred page medical record will be one file.
  • Multiple charts can be sent on one CD/DVD but each chart request must be a separate PDF/TIFF file.
  • The image file name MUST be “Provider NPI-Claim number”. For example if the claim number 123456 is requested and the provider NPI was 654321, the filename would be 654321-123456.pdf or 654321-123456.tiff
  • Label on 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>, your facility name.
  • We strongly suggest sending all medical records to Performant Recovery via traceable carriers (FedEx, UPS, DHL, registered USPS mail, etc.)
  • Please send CD/DVD images in a tamper-proof, padded packaging. 

     

  • Submission of Fax Medical Records

    • Fill out a clear, complete fax cover sheet with the correct number of pages to be sending.  The ADR barcode sheet MUST be sent as the second page (first page is the coversheet).

    • Configure your fax machine to send faxes as they are scanned, i.e. do not use a memory send mode.

    • Send faxes at 200x200dpi resolution with normal quality.  Please do not send with 'Fine' or 'Super Fine'.

    • Please use the highest transmission rate available.

    • Having the fax machine on its own dedicated phone line is always best practice.

    • If your fax machine is capable of taking a phone call, please set your machine to fax only.

    • Please only send 1 fax at a time.  Please wait until the previous fax has been fully sent before loading more documents.  Just as with any other record submission, each record should be sent separately with the ADR Barcode sheet included.

    • Configure your fax machine to include header information.  The Fax number or sender name is generally used.

  • Submission of Paper Medical Records

    • Include the original or copy of the additional documentation request (ADR) letter.
    • Use standard 8 1/2 X 11 paper -- No 3-hole punched paper will be accepted.
    • Free of staples/staple holes.
    • Pages should be top faced, and face up.
    • Photocopy must be of good quality and legible.
    • Records must be copied on only one side.
    • Highlight claims on the letter identifying the medical record attached.
    • Individual charts should be secured with rubber bands or paper clips.

      Send all medical records to:

Performant Recovery Inc.

2819 Southwest Blvd

San Angelo, TX 76904

PREPAY REVIEW (Therapy Cap)
Performant Recovery Inc.
2819 Southwest Blvd
San Angelo, TX 76904

PREPAY REVIEW DEMONSTRATION 2014
Performant Recovery Inc.
2815 Southwest Blvd
San Angelo,  TX  76904


 

• Please visit the following CMS web page for background on esMD.
  https://www.cms.gov/ESMD/
• Scanned image resolution must be clear and legible. 300 dpi and in black and white.
• Image format must be in either PDF or TIFF format though PDF is preferred
• For PDF format, DO NOT password protect the individual PDF files.

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