Provider Medical Record (MR) Submission Requirements (Paper/CD/DVD)
DUE DATE: 45 days from the date of the medical record request letter

Paper Medical Records

• 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.

CD/DVD Medical Record Submission Requirements:

Attention
Prior to an ongoing submission of medical records via a CD/DVD, a provider will have to perform a successful test of transferring medical records with Connolly Healthcare. A successful test will be contingent on the below specifications being met:

MRs Format

• Scanned image resolution must be 300 dpi and in black and white
• Image format must be in either .TIFF or .PDF format
• Each medical record should be its own file regardless of its size. For example, a two hundred page medical record will be one file.
• Only one provider is allowed for each CD/DVD.
• Each CD/DVD should have the maximum number of medical records possible burned onto it.
• 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

MRs 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>

If medical images are encrypted using PGP, public and private keys to decrypted image files must be established prior to shipment.

MRs 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.).