Requests for medical records can be a burden on physicians and other clinicians; however, Humana works to make submitting requested records as easy as possible for physician offices and facilities by offering online, fax and postal mail submission options. Find out more here.
When submitting an authorization request, it is especially important for physicians and other clinicians to supply all pertinent clinical information to support the medical necessity of the services requested. “Pertinent clinical documentation” includes, but may not be limited to, some or all of the following: explanation of relevant symptoms, treatment plan, history and physical exam, office notes, results of diagnostic testing, previous treatments/procedures and medications that have been tried.
If a physician or facility does not provide the necessary information, Humana may be required to deny the service(s) requested for lack of medical necessity, per established Centers for Medicare & Medicaid Services (CMS) guidelines. Please note that CMS expects health plans like Humana to obtain medical records and information from contracted physicians and clinicians in a reliable and timely manner, which ensures all parties operate with patients’ best interests as their first priority.
The requirement to submit requested medical records is part of Humana’s provider agreements with its participating physicians and clinicians. Additional details can be found in Humana’s Provider Manual, which is posted on Humana.com/publications.