Claim Audit Information for Providers

Submitting Medical Documentation

The preferred method to send medical documentation files is electronically, either through a secure file transfer protocol that we will set up for you, or via the optional Provider Portal (if your health plan has chosen this service).

Electronic file transfer is also the fastest and most convenient method for most providers, and providers industry-standard security for protected health information.

Set Up an SFTP Connection

To set up an SFTP connection call the HMS Provider Relations center at (866) 875-1749. HMS will need contact information for the appropriate individuals in your Health Information Management and Information Technology teams. Our electronic data interchange department will contact them to begin the setup process for the transfer.

Alternate Methods

Additional options are noted in the record request notification you received, including instructions for submitting records via fax, U.S. Mail or on CDs or DVDs.

Ensure Your Documentation Meets these Standards

Following these tips for submitting medical documentation will help ensure your documentation is received and processed properly the first time.

  • Provide clear, legible documentation with good quality image scans. These records should support the services provided for the dates of service requested, including inpatient admission orders, physician documentation and notes, and physician orders.
  • Some medical records systems, such as PowerPlan, use a digital method for authenticating physician orders or validating provider intent for inpatient status. This detail is not visible in a standard printout of the record. If your system uses a method similar to this, please ensure that the authentication or validation is included with your medical record submission – it may not be included automatically when sending electronic records.

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