180.985        Insurance Company Requests for Medical Records:

MSSNY will:
Seek legislation/regulation which requires that when insurance carriers request copies of medical records:

  1. They allow at least 30 days for physicians to forward the records to the requestor;
  2. There be a clear identification as to the reason for requesting the medical records;
  3. Physicians be notified as to the outcome of the medical record review;
  4. A reasonable cap be placed on the number of records an insurance carrier can  request per patient;
  5. They follow the guidelines of the Recovery Audit Contractors (RACs) Summary of
    Additional Documentation Limits as listed below:
    Sole Practitioner:  10 medical records per 45 days per NPI
    Partnership (2-5 individuals):  20 medical records per 45 days per NPI
    Group (6-15 individuals):  30 medical records per 45 days per NPI
    Large Group (16+ individuals):  50 medical records per 45 days per NPI;
  6. Requiring the managed care organization to render, in advance, a per-page fee,  pursuant to Public Health Law Section 18.
  7. Reaffirm and actively pursue legislation in accordance with MSSNY Policies 180.988, 180.989, 180.992, 180.995.
  8. Ensure that the drafted legislation include language that clarifies the physician’s ability to charge and collect for any/all postage costs.  (HOD 2010-257; Reaffirmed HOD 2020)