Optum Comprehensive Payment Integrity - Medical Records Requests
Optum CPI ensures that claims process and pay accurately. This may result in a claim denial with a request for medical records from the provider or supplier who submitted the claim to support the services submitted on the claim. Providers should submit adequate medical record documentation that supports the services billed to the address in the medical record request letter within 30 calendar days.
If Optum does not receive the requested records, Optum will make a determination on the claim based upon the available information which may result in the denial being upheld.
To ensure medical records are routed appropriately and reviewed in a timely manner, the medical records should not be submitted via reconsideration or appeal.
Records can be submitted to Optum via:
- SECURE INTERNET UPLOAD (cover sheet not required)
- HARD COPY (i.e., paper copy)
- On a CD/DVD
Documents should be organized by placing all medical records for a recipient and date of service behind the enclosed barcoded cover sheet on which the recipient’s name and the date of service are printed.
If you have any questions or concerns, please feel free to contact Optum at 877-564-7503.