The Role of Additional Medical Record Requests in Claim Reviews

During a claim review, it is not uncommon for additional medical records to be requested. This is typically done to clarify discrepancies or to gather a more complete picture of the claimant’s health history, especially when there is a gap in records or a large lapse in time.

Sometimes, the records initially submitted do not provide enough detail for a reviewer to make a conclusive determination. For example, follow-up notes, imaging results, or treatment plans from specialists may be missing. Requesting these documents is not meant to delay the process but rather to ensure the reviewer has every piece of information needed to make a fair and medically sound decision.

By securing a complete record, reviewers help safeguard the integrity of the process and improve the accuracy of claim outcomes. Moving forward with “what you have” could be a costly mistake to make!