Medical Records, Stat!
Most questions we receive regarding pre-pay clinical claim review involve prompt pay. They tend to come down to, “How can I complete a clinical claim review within prompt pay guidelines?”So let’s first address prompt pay guidelines. Prompt pay guidelines are based on specific requirements of the program and/or a contract between the plan and the provider. The Centers for Medicaid and Medicare Services and most contracts do allow for additional timing when a claim requires review of documentation for a payment determination.