Wiki Appeal with referring doctor notes?

[ngastroent]

We have a denied claim for a patient that was referred to us. I found the medical necessity guidelines (their denial reason) which our notes (in my opinion) prove it, but the referring doctor notes have more proof. With HIPAA, are we allowed to submit the referring doctor's notes since they were sent to us specifically to treat this patient?

 

[thomas7331]

Yes, per my understanding HIPAA allows providers to disclose patients' PHI to their health plans for payment or healthcare operations purposes, subject to the 'minimum necessary' guidelines - that would apply whether you are submitting your own notes or another provider's records. You are not required to obtain a specific authorization from the patient or from the other provider for this.

 

[ngastroent]

Yes, per my understanding HIPAA allows providers to disclose patients' PHI to their health plans for payment or healthcare operations purposes, subject to the 'minimum necessary' guidelines - that would apply whether you are submitting your own notes or another provider's records. You are not required to obtain a specific authorization from the patient or from the other provider for this.

Thank you!!