Audit Failure Denials
You are required to submit, or provide access to, medical records upon our request. Failure to do so in a timely manner may result in an audit failure denial, resulting in an overpayment. Medical record requests that do not comply with the guidelines in the Overpayments section of Chapter 9: Our Claims Process follow the auto failure denial process.
In addition to the initial medical record request notification sent with all audited claims, audit failure denial claims asks for additional information and notifies care providers of the audit failure denial process, overpayment, and future actions.