Medical Records
This is the most common type of information a payer might request when issuing a CO 252 denial.
What are medical records?
Before rendering payment for a procedure or surgery, payors may request this document to confirm it was submitted and the procedure was approved in advance.
What is prior authorization or pre-certification?
This portal is used to submit additional documents to United Healthcare.
What is the United Healthcare Portal?
This denial code is used when a claim is put on hold because the payer needs more information or records to process it.
What is CO252?
An Office Visit medical record can be found on this tab.
What is the Encounter tab?
This part of Epic is where medical records are located.
What is the chart?
Payors give us the option to submit this when we disagree with their denial of a claim.
What is an appeal or reconsideration?
This portal is used to submit additional documents to Cigna.
What is the Cigna portal?
An ADR denial may include this remark/RARC code.
What is C016?
Chart tab where you would locate an Operative report
What is the Encounter tab?
This document explains what was done during a surgery, as well as why and by whom
What is an operative report?
These payors allow providers to submit supporting documentation before a claim is officially denied.
What are Humana, Medicare, United Healthcare, and Cigna?
This portal is used to submit additional documents to Medicare.
What is Connex?
Payors use this alpha prefix to notate the payment is due by the patient.
What is PR?
Chart tab where you would locate an ultrasound or X-ray
What is the Imaging tab?
This is the most common reason for C0252 denials.
What are missing medical records?
Payors typically use this method to request additional documentation during a post-payment review.
What is a letter?
This portal is used to submit additional documents to Medicare Railroad.
What is Palmetto GBA?
This is what "CO" in CO252 means.
What is contractual obligation?
Alternate chart tab where you might find an Operative report if it cannot be found on the Encounter tab
What is the Notes tab?
If Radiology Oncology medical records cannot be found in Epic, they might be found in this system
What is Varian?
Payors will send this document letting us know the breakdown of the claim and who's responsible for payment.
What is an EOB (Explanation of Benefits) or remit?
This portal is used to submit additional documents to Humana.
What is Availity?
This is the description of CO252.
What is "AN ATTACH/OTH DOC IS REQ TO ADJ CLAIM?"
Hospital records can sometimes be found on this tab if they are not available on the Encounter tab.
What is the Media tab?