Medical Record Submission

Connolly has partnered with HealthPort to create a secure point to point connection that will accept electronic transmissions of medical records from HealthPort responding to RAC complex reviews.

For more details on the Connolly/HealthPort connection, please contact HealthPort at
1-800-737-2585.

Connolly will now accept medical records from participating Health Information Handlers (HIHs). A complete list of HIHs is available at https://www.cms.gov/ESMD.  Please contact your HIH if you wish to submit medical records through esMD.

1. Scan a copy of Connolly’s medical record request letter.
   
   
2. Save the request along with all requested copies of medical records as a PDF or TIFF file (B&W only please) on a CD or DVD.  Each medical record should be one file; please do not save individual pages as files.
   
   
3. Please also include an Excel file on the CD/DVD with the following information:
   
   
   • Patient Information:  Name (first and last); DOB (date of birth); Account/Control number; HIC number (Health Insurance Claim number/patient ID on the Medicare card); Medical record number
     
     
   •  Dates of Service:  The date the patient’s service began and ended
     
     
   • Provider Information:  Name (full name), Provider Number and NPI (National Provider Identifier)
     
     
   • Other Important Numbers:  Requested claim number; Medical record number
     
     
   •  The number of pages or size of file of the image and the total number of medical records recorded on the CD/DVD.
    
4. The file name must match the Claim Number.
   
5. Send the CD or DVD to:        

•  Encryption:  We strongly recommend all images be encrypted with WinZip and password protected, with the password sent separately to: RACINFO@connolly.com.  This email should include: Provider ID, Sent date (MM-DD-YY), and number of images.  If PGP data encryption is used, public and private keys must be established prior to shipment.  
  
  
• Sending:  When sending CDs or DVDs, please put them in a tamper-proof package and name them according to this convention:  <Provider ID>_<date sent in MM-DD-YYYY format>_<number of images> and please track them through the carrier you choose (FedEx, UPS, DHL, USPS registered).  
  
  
• Acknowledgement of Receipt:  Once Connolly receives the CD or DVD, it will be processed and an acknowledgement fax and/or email sent to you (the contact you have pre-designated in the Request for Contact information form.  Connolly will provide the CD/DVD name, the date the disk was received, the date the disk was processed and its status (either accepted or rejected). Reasons for rejection include:  CD/DVD’s with any encryption aside from WinZip or PGP, file count mismatch, page count mismatch, missing metadata file.
  
  
• Contact us: If you have any questions, please call our RAC hotline at 866.360.2507.

1. Include the original or a copy of the medical record request letter from Connolly, the Recovery Audit Contractor (RAC). 
   
   
2. On the letter, use a highlighter to show which claims you are attaching.
   
   
3. Send the letter and the attachments to: 
                                                          Connolly Healthcare
                                                          555 North Lane, Suite 6125
                                                          Conshohocken, PA  19428