Medical Record Submission Requirements
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
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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
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Scanned image resolution must be 300 dpi and in black
and white
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Image format must be in either .TIFF or .PDF format
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One image per medical record, i.e., multiple-page image
file. For example, a two hundred page medical record will be
one file.
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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
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Copy of our medical record request letter
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The following metadata (excel file or tab delimited
text file) must be included with the image submission
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Requested Claim Number
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Begin Date of Service
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End Date of Service
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Patient name (first and last name)
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Patient DOB
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Patient HIC Number
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Patent Account/Control Number
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Medical record number
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Provider Name (full name)
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Provider Number
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Provider NPI
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Number of pages or the file size of the image
submitted for acknowledgement purposes
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Total number of medical records on the CD/DVD
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There should be one entry per image in the metadata
file
MRs
Submission
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Images are to be sent via CD or DVD in a tamper-proof
package
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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>
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For security purposes it is strongly suggested that all
images sent should be encrypted and password protected.
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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>
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If medical images are encrypted using PGP, public and
private keys to decrypted image files must be established prior to
shipment
MRs
Acknowledgement
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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:
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CD/DVD Name
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Received Date
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Processed Date
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Status: Accepted / Rejected
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Reason for rejection: file count mismatch; page count
mismatch; missing metadata file
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The whole CD/DVD will be rejected if it fails
validation
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It is strongly suggested that images sent on CD/DVD
should be sent via trackable carriers (FedEx, UPS, DHL, registered USPS mail, etc.).