226: Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete

On Call Scenario:

                                          Claim denied as Medical Records Requested
                                                                         ↓
                                                       May I get the denial date?
                                                                         ↓
                                      What is the Fax# or Mailing address to send the MR?
                                                                         ↓
                                         How much is the time limit to send the records?
                                                                         ↓
                                                May I have the claim# & call ref#?

Important Note:

• Calculate the time limit from the denial date, if it is not crossed then send the MR or else write off the claim if the time limit is crossed.
• Sometimes the client wants us to send MR even if the time limit is crossed, so work accordingly.
• Always check the remark code given with the denial reason, sometimes it provides the exact reason for denial that could differ. So follow the AR scenario tool to work the exact denial.

Prepare Notes:

Source of Status:

* Call Website EOB System

Clearing House Comment (Please make the changes if required):

Insurance Name:

*

Clearing House Name:

Insurance Phone#:

*

Rep Name:

*

Website Name:

*

Denial Date:

*

Mode to Send MR:

* Fax Mail Website

Fax Number:

*

Mailing Address:

*

Website Link:

*

Time Limit:

*

Additional Comment:

Claim Number:

*

Call Reference#

*

Action:

* Need client assistance Need to submit an appeal MR sent Adjusted off the claim



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