RAC+Submission+Requirements

Connolly is tasked with auditing __Region C__, which consists of the states of:
 * AL, AR, CO, FL, GA, LA, MS, NC, NM, OK, SC, TN, TX, VA, WV** and the territories of **Puerto Rico** and **U.S. Virgin Islands** which makes up 39% of the United States. Region C is the largest of the four RAC regions

Submitting medical records to Connolly is easy! Just follow these simple steps: Connolly has partnered with HealthPort to create a secure point to point connection that will accept electronic transmissions of medical records from HealthPort responding to RAC complex reviews. For more details on the Connolly/HealthPort connection, please contact HealthPort at
 * __ Direct Electronic Connection with HealthPort __**

1-800-737-2585 or visit their website [|www.healthport.com/esend]

Attn: CD/DVD Submission Connolly Healthcare 1 Crescent Drive Ste 300A Philadelphia, PA 19112-1015
 * __CD or DVD Records: __**
 * 1) Scan a copy of Connolly’s **medical record request** letter.
 * 2) Save the request along with all requested copies of medical records as a PDF or TIFF file (B&W only please) on a CD or DVD. Each medical record should be one file; please do not save individual pages as files.
 * 3) Please also include an Excel file on the CD/DVD with the following information:
 * //Patient Information: // Name (first and last); DOB (date of birth); Account/Control number; HIC number (Health Insurance Claim number/patient ID on the Medicare card); Medical record number
 * //Dates of Service: // The date the patient’s service began and ended
 * //Provider Information: // Name (full name), Provider Number and NPI (National Provider Identifier)
 * //Other Important Numbers: //<span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Requested claim number; Medical record number
 * <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 13.3333px;">The number of pages or size of file of the image //and// the total number of medical records recorded on the CD/DVD.
 * 1) <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 13.3333px;">The file name must match the Claim Number.
 * 2) <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Send the CD or DVD to:


 * __<span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Please Note the Following: __**
 * **<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Encryption: **<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">We strongly recommend all images be encrypted with WinZip and password protected, with the //password sent separately// to: RACINFO@connolly.com. This email should include: Provider ID, Sent date (MM-DD-YY), and number of images. If PGP data encryption is used, public and private keys must be established prior to shipment.
 * **<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Sending: **<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;"> When sending CDs or DVDs, please put them in a tamper-proof package and name them according to this convention: <Provider ID>_<date sent in MM-DD-YYYY format>_ and please track them through the carrier you choose (FedEx, UPS, DHL, USPS registered).
 * **<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Acknowledgement of Receipt: **<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;"> Once Connolly receives the CD or DVD, it will be processed and an acknowledgement fax and/or email sent to you (the contact you have pre-designated in the Request for Contact information form. Connolly will provide the CD/DVD name, the date the disk was received, the date the disk was processed and its status (either accepted or rejected). Reasons for rejection include: CD/DVD’s with any encryption aside from WinZip or PGP, file count mismatch, page count mismatch, missing metadata file.


 * <span style="font-family: 'Arial','sans-serif';">Diversified Collection Services, Inc. of Livermore, California , **<span style="font-family: 'Arial','sans-serif';"> in Region A, initially working in Maine , New Hampshire , Vermont , Massachusetts , Rhode Island and New York.

DCS http://www.dcsrac.com/documentation.html
 * Provider Medical Record Submission Requirements **


 * Record Requirements **
 * Please note that the additional documentation and medical records **<span style="color: #000000; font-family: 'Calibri','sans-serif'; font-size: 13.3333px;">are due 45 days ** from the date of the additional documentation request letter. An extra 10 days will allowed for shipping time to insure that the providers have the full 45 days to assemble the medical records.
 * Please be sure documentation submitted is legible
 * Please submit required documentation and any additional documentation that supports the procedures/codes billed for all dates of services related to the claim.

<span style="color: #000000; display: block; font-family: 'Times New Roman','serif'; font-size: 13.3333px; text-align: left;">**Medical Record (MR) Submission Requirements (Paper/CDs or DVDs)** <span style="color: #000000; display: block; font-family: 'Times New Roman','serif'; font-size: 13.3333px; text-align: left;"> <span style="color: #000000; display: block; font-family: 'Times New Roman','serif'; font-size: 13.3333px; text-align: left;">**Paper Medical Records**
 * Include the original or copy of the additional documentation request letter (ADR) from the RAC.
 * If possible, highlight claims on the letter identifying the medical record attached.

<span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 13.3333px;">CDs or DVDs Medical Records:

 * Scanned image resolution must be clear and legible. 300 dpi and in black and white is preferred, though images with less resolution will be accepted as long as the quality is sufficient for the medical review staff.
 * Image format must be in either TIFF or PDF format though TIFF is preferred.
 * One image per medical record, i.e., multiple-page image file. For example, a two hundred page medical record will be one file.
 * The image file name must be “provider NPI-Claim number”. For example if the claim number **123456** is requested and the provider NPI was **654321**, the filename would be **654321-123456.pdf** or **654321-123456.tiff**

[]


 * <span style="font-family: 'Arial','sans-serif';">CGI Technologies and Solutions, Inc. of Fairfax, Virginia, **<span style="font-family: 'Arial','sans-serif';"> in Region B, initially working in Michigan, Indiana and Minnesota

** Medical Record Submission Instructions ** ** Medicare’s CGI RAC Region B ** Records are accepted in **paper format** and on **CD** or **DVD**. Paper medical records must meet the following requirements: Free of staples and paperclips. Pages should be top faced, and face up. Photocopy must be of good quality and legible. Include a copy of the CGI RAC B Additional Documentation Request Letter (medical record request letter). Records must be copied on only one side.
 * <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 15.3333px;">DUE DATE: 45 days ** from the date on the medical record request letter
 * Paper Records **

CGI RAC Region B encourages providers to submit medical records in imaged format via CD or DVD. Imaged medical records must meet the following requirements: Scanned image resolution must be 200 dpi and in black and white. Image must be in the TIFF, with Group 4 compression, or in PDF format. CGI would prefer the TIFF format. For the use of any other formats, please contact the CGI RAC Region B Call Center at 1‐877‐316‐RACB (7222) prior to sending the files. For PDF format, DO NOT password protect the individual PDF files. Instead, zip all PDFs into a WinZip file and encrypt it, or use PGP encryption. Multipage documents must be in one image. For example, a 50 page medical record will be one image file. Scanned image must be legible. The image file naming convention must be as follows; <Patient Name>_<Admit Date/Date of Service>. For example, if the Patient Name is John Smith and the date of service is October 1, 2008, then the file will be named JohnSmith_10012008.tif. Include a copy of only the first page CGI RAC B Additional Documentation Request Letter (medical record request letter); you can include the first page on the CD/DVD, but please do not encrypt it; all Medical Records must be encrypted.
 * Imaged Records **

Label the CD or DVD according to the following naming convention; <Provider Facility Name>_<medical record request letter date in YYYYMMDD format>. Example: MercyHospital_20091212. Please send all medical records, both paper and CD or DVD, in tamper proof packaging, such as security mailers, tamper evident mailers, or security labels.
 * Medical Record Submission **

For security purposes, all images sent should be encrypted either in a WinZip file that is password protected, or by using PGP encryption. For encrypted WinZip files: Use your Additional Documentation Request Letter ID (medical record request letter) as the password. For Providers that use a version of WinZip that requires 8 characters to encrypt, please place zeros BEFORE the Letter ID; i.e. 00075231. For encrypted PGP files: Contact CGI RAC Region B prior to shipment to obtain the Public Encryption key. This can be accomplished by calling our CGI RAC Region B Call Center at 1‐877‐316‐RACB (7222).
 * Encryption **

Medical records for Indiana, Illinois, Kentucky, Michigan and Ohio: CGI Federal Inc. 1001 Lakeside Ave., Suite 800 Cleveland, OH 44114 Medical records for Minnesota, Wisconsin, DME and Home Health: PO BOX 742888 Atlanta, GA 31139‐9998
 * Send medical records as follows: **
 * Attn: RACB **
 * Attn: Medicare Recovery Audit Subcontractor ‐ Region B **


 * Medical Records Submission **


 * Label the CD or DVD according to the following naming convention for easy communication, tracking, and reconciling purposes: <Provider NPI>_<sent date in **MM-DD-YYYY** format>_
 * For security purposes it is recommended that all images sent should be encrypted or password protected.
 * A password will be provided in the medical records request letter
 * If medical images are encrypted using PGP, public and private keys to decrypted image files must be established prior to shipment

DCS Healthcare Services 2815 Southwest Blvd San Angelo, TX 76904
 * We strongly suggest sending all medical records to DCS via trackable carriers (FedEx, UPS, DHL, registered USPS mail, etc.)
 * Please send CD/DVD images **//in a tamper-proof package.//**
 * Send all medical records to:

HCI []
 * <span style="font-family: 'Arial','sans-serif';">HealthDataInsights, Inc. of Las Vegas, Nevada, **<span style="font-family: 'Arial','sans-serif';"> in Region D, initially working in Montana, Wyoming , North Dakota , South Dakota , Utah and Arizona.

<span style="color: #000000; font-family: 'Times New Roman','serif';">Please adhere to the following instructions when submitting a record via CD/DVD: <span style="color: #000000; font-family: 'Times New Roman','serif';"> Attach a copy of the pull list in front of the imaged record with the corresponding patient name circled
 * <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 15.3333px;">How to submit records to HDI via CD/DVD: **
 * <span style="color: #000000; font-family: 'Times New Roman','serif';">Format: **

<span style="color: #000000; font-family: 'Times New Roman','serif';"> Scanned image resolution must be between 200-300 dpi and in black and white

<span style="color: #000000; font-family: 'Times New Roman','serif';"> Scanned image must be legible

<span style="color: #000000; font-family: 'Times New Roman','serif';"> File must be in a PDF or TIFF with Group 4 compression format (PDF preferred) <span style="color: #000000; font-family: 'Times New Roman','serif';"> Each image file naming convention must include the reference number listed on the HDI pull list. If another document for the same reference number has been shipped before, an extension code is required to provide uniqueness between files.

<span style="color: #000000; font-family: 'Times New Roman','serif';">Example: __First time sending__: 000ABC.pdf or 000ABC_1.pdf __Second time sending__: 000ABC_2.pdf <span style="color: #000000; font-family: 'Times New Roman','serif';">• The following metadata (excel file or tab delimited text file) must be included with the image submission: <span style="color: #000000; font-family: 'Times New Roman','serif';">- Requested Reference Number (located on HDI pull list) <span style="color: #000000; font-family: 'Times New Roman','serif';">- Requested Claim Number (located on HDI pull list) <span style="color: #000000; font-family: 'Times New Roman','serif';">- Begin Date of Service <span style="color: #000000; font-family: 'Times New Roman','serif';">- End Date of Service <span style="color: #000000; font-family: 'Times New Roman','serif';">- Patient name (first and last name) <span style="color: #000000; font-family: 'Times New Roman','serif';">- Patient DOB <span style="color: #000000; font-family: 'Times New Roman','serif';">- Patient HIC Number <span style="color: #000000; font-family: 'Times New Roman','serif';">- Patient Account/Control Number <span style="color: #000000; font-family: 'Times New Roman','serif';">- Medical record number <span style="color: #000000; font-family: 'Times New Roman','serif';">- Provider Name (full name) <span style="color: #000000; font-family: 'Times New Roman','serif';">- Provider Number <span style="color: #000000; font-family: 'Times New Roman','serif';">- Provider NPI <span style="color: #000000; font-family: 'Times New Roman','serif';">- Number of pages or the file size of the image submitted <span style="color: #000000; font-family: 'Times New Roman','serif';">- Total number of medical records on the CD/DVD <span style="color: #000000; font-family: 'Times New Roman','serif';">There should be one entry per image in the metadata file. <span style="color: #000000; font-family: 'Times New Roman','serif';">Multiple charts can be sent on one CD/DVD but each chart request (reference #) must be a separate PDF/TIFF file. <span style="color: #000000; font-family: 'Times New Roman','serif';">CD/DVD should be labeled as <Provider Facility name>_<Medical record request letter date: MMDDYYYY>_<Number of images on CD/DVD> <span style="color: #000000; font-family: 'Times New Roman','serif';">Example: Hospital_01012010_4 <span style="color: #000000; font-family: 'Times New Roman','serif';">If CD/DVD contains records from multiple medical record request letters, please use the range of dates from the medical record request letters in the CD/DVD naming convention. <span style="color: #000000; font-family: 'Times New Roman','serif';">Example: Hospital_01012010-02012010_4 <span style="color: #000000; font-family: 'Times New Roman','serif';">CD/DVDs do not require encryption but it is recommended for security purposes. If encryption/password protection is desired, the following common WinZip options are accepted: <span style="color: #000000; font-family: 'Times New Roman','serif';"> Zip 2.0 compatible encryption
 * <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 15.3333px;">Submission: **

<span style="color: #000000; font-family: 'Times New Roman','serif';"> 256-Bit AES encryption

<span style="color: #000000; font-family: 'Times New Roman','serif';"> PGP Encryption

<span style="color: #000000; font-family: 'Times New Roman','serif';">If a password is required to open a zipped CD/DVD please submit that password to HDI, prior to shipment, via one of the methods below. Please provide a record identification reference (reference number/claim number/audit number) for identification. <span style="color: #000000; font-family: 'Times New Roman','serif';">• FAX password to 702-240-5595 •

<span style="color: #000000; font-family: 'Times New Roman','serif';"> E-mail password to racinfo@emailhdi.com •

<span style="color: #000000; font-family: 'Times New Roman','serif';"> Call (866) 590-5598 and provide password to a Provider Service Representative NOTE – Do not leave the password on the HDI voice mail If PGP encryption is used, public and private keys to decrypt images must be established with HDI prior to shipment. <span style="color: #000000; font-family: 'Times New Roman','serif';">All medical documentation mailed to HDI via paper or CD/DVD should be sent in tamper-evident packaging such as security mailers or tamper sticker labels.