Why medical records requests get rejected, and how to catch it before you send

A rejected medical records request costs a personal injury case time it usually cannot spare. The provider sends the request back, sometimes weeks later, and the clock starts over. In most cases the reason was already on the page when the request left your office.

This article covers the defects that cause most rejections and a short checklist you can run before sending.

Where rejections come from

The signature or date is missing

An authorization that is unsigned, or signed without a date, is not a valid authorization. This is the most common defect and the easiest to catch. Check that the client or their authorized representative signed and dated the form, and that the signature is legible enough for the provider's staff to accept.

The authorization has expired

Authorizations carry an expiration date or an expiring event. A form signed months ago for an earlier stage of the case may no longer be good by the time a follow-up request goes out. Check the expiration against the day you are sending, not the day the client signed.

The date range is missing, vague or wrong

Providers release what the authorization describes. A request with no date range, or a range that stops before the treatment you need, gets you an incomplete set of records or a rejection. State the range explicitly and make sure it covers the full course of treatment.

The provider name does not match the record holder

Hospitals, affiliated practices, billing companies and imaging centers are often separate entities. An authorization naming a hospital may not cover a physician group that practices inside it. Confirm that the name on the form is the entity that actually holds the records you want.

Required statements are missing

Under the federal HIPAA Privacy Rule, a valid authorization has to include certain core elements: a description of the information to be released, who may release it, who may receive it, the purpose, an expiration, and the individual's signature and date. It also has to include statements about the right to revoke, about conditioning treatment on signing, and about the possibility that released information is disclosed again. Some states and some providers add their own requirements. A form that leaves any of this out is a common reason for rejection.

The request goes to the wrong place

A correct request sent to the wrong department waits in the wrong queue. Medical records, billing and imaging often have separate intake points, and each may accept only certain methods, such as a portal, a fax number, a mailing address or an email. Confirm the department and the method before you send.

A checklist to run before every request

1. The client name matches the name the provider has on file.
2. The date range is stated and covers all the treatment you need.
3. The provider named on the form is the entity that holds the records.
4. The expiration date has not passed, and will not pass before the provider can respond.
5. The form is signed and dated.
6. All required statements are present, including any your state or the provider adds.
7. The request is addressed to the right department and goes by the method that department accepts.

When a request does come back

Write down the reason the same day, fix it, and resend. Record the original send date, the date of the rejection and the reason in the request's history. That record shows where time was lost, and it tells you which defect to look for first on the next request to that provider.

This article is general information, not legal advice. Requirements differ by state and by provider, and your firm is responsible for the sufficiency of its requests.

DocHound runs this kind of check automatically when you upload an authorization, and flags what needs fixing before the request goes out. See how it works.