Return copy of claim to provider?

[PamelaGraham]

It is rare that a provider asks for a copy of a claim they've submitted (I work for a payer). When I have been asked in the past, it was to troubleshoot discrepancies with the clearinghouse... This time I'm being asked because the provider was asked to conduct a self-audit and claims their new biller didn't know he needed to keep a copy of what was charged.

I don't find any OARS (Oregon Administrative Rules) that address whether this is a required element they need to retain, and am looking for a resource to definitively say whether a copy can (or should) be provided.

 

[Skymom]

CMS guidelines for record retention should be followed unless the State requirements are more stringent. Any covered entity (which includes third-party medical billers and physicians who bill Medicare/Medicaid) needs to follow these guidelines. Maybe this article will at least give you a starting point:

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/SE1022.pdf


And this also may be useful:
http://www.healthinfolaw.org/compar...red-health-care-providers-50-state-comparison