A technical denial is issued after the third failed attempt to obtain medical records from the health care provider of service on a claim. The time line for this request is as follows:
- Initial Request: A letter is delivered to the health care provider asking that records be provided within 30 days of the date of the letter
- Second Request: If the requested records are not received within 30 days of the initial letter, a second letter is delivered to the health care provider, allowing an additional 30 days to respond.
- Final Request: If the requested records are not received within 30 days of the second request, a final request letter is delivered to the health care provider, including the technical denial language. The letter informs the health care provider that if records are not received within 15 days, a technical denial will be issued.
If there is still no response within 15 days of the final request, the health care provider will receive a letter from financial recovery stating that a technical denial has been issued. The health care provider then has 60 days to send in the records before the amount is remit deducted.
Humana will follow all federal and state laws and regulations. When more than one state is impacted by a particular issue, to allow for consistency, Humana will follow the most stringent requirement.
This standard is subject to change or termination by Humana at any time. Humana has full and final discretionary authority for its interpretation and application. This standard supersedes all other Humana policies, standards or information conflicting with it.