Medical Record Requests

In the event Medica or an authorized agent working on Medica's behalf requests medical records from a participating provider, such provider must honor the request within 14 calendar days, or sooner if required to comply with regulatory, accreditation or contractual obligations.

Such requests may include, but not be limited to, requests associated with provider or member complaints, risk adjustment, Federal or state claims audits, utilization review, care management reviews, claims appeals or quality improvement programs. When such a request is made of a provider, access to the complete medical record, including all flow sheets and scanned documentation, either by electronic means or hard copy for the specified time period, must be allowed.

Medica does not reimburse participating providers for the cost of collecting, copying or delivering requested medical records, except when required by law. Participating providers, and any subcontractors or third parties who may collect, copy and/or deliver records for such providers, may not bill Medica or any Medica member for expenses related to a records request from Medica or an authorized agent working on Medica's behalf.

REV 1/2024