Action for ins denial - Require medical records or Denied for Medical Necessity

Denial Reason :

Require medical records or Denied for Medical Necessity

Action :

In the first opinion of the carrier, they may feel that the procedure may not be necessary for the diagnosis specified. Hence the request for medical records. We should pull out the medical records from the charge file, take copies of it, attach it along with the claim with a covering letter and send it. Analysis should be done to resubmit all claims with the given procedure-diagnosis combination for the insurance carrier with medical records.

Posted in: Denial and action