RAC medical record submission requirements

• Include the original or copy of the medical record request letter from the RAC. If possible, highlight claims on the letter identifying the medical records attached.

• Medical Records Format
  • Scanned image resolution must be 300 dpi and in black and white
  • Image format must be in either .TIFF or .PDF format
  • 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 the requested claim number. For example if the claim number 123456 is requested, the filename would be 123456.pdf or 123456.tif
  • Copy of our medical record request letter
  • The following metadata (excel file or tab delimited text file) must be included with the image submission
    • Requested Claim Number
    • Begin Date of Service
    • End Date of Service
    • Patient name (first and last name)
    • Patient DOB
    • Patient HIC Number
    • Patent 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
    • Total number of medical records on the CD/DVD
  • There should be one entry per image in the metadata file
• Medical Records Submission
  • Images are to be sent via CD or DVD in a tamper-proof package
  • CD or DVD should follow the following naming convention for easy communication, tracking , and reconciling purposes: <Provider ID>_<sent date in MM-DD-YYYY format>_<number of images>
  • For security purposes it is strongly suggested that all images sent should be encrypted and password protected.
    • If medical images are encrypted through Winzip, a separate email to the MR address located at www.connollyhealthcare.com should be sent to Connolly with the password needed to unzip the files referencing: <Provider ID>_<sent date in MM-DD-YYYY format>_<number of images>
      o If medical images are encrypted using PGP, public and private keys to decrypted image files must be established prior to shipment
• Medical Records Acknowledgement
  • Once Connolly receives the CD or DVD it will be processed and a fax and/or email will be sent to the provider’s medical record contact person (identified on the Request for Contact Information Form) with the following information:
    • CD/DVD Name
    • Received Date
    • Processed Date
    • Status: Accepted / Rejected
    • Reason for rejection: file count mismatch; page count mismatch; missing metadata file
  • The whole CD/DVD will be rejected if it fails validation
  • It is strongly suggested that images sent on CD/DVD should be sent via trackable carriers (FedEx, UPS, DHL, registered USPS mail, etc.).