CLX Pet Medical Records for MRR

Medical Records for MRR

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Medical Records for MRR - Verification Guidelines prior to MRR

Steps that should always be taken before submitting an MRR...

Ensure Accuracy of Submission

Confirm the Claim needs an MRR

Really, really check those MRs!

• All disclosed vets have SOAPs through the review period. If PH reported 2 vets at sign-up, there needs to be 2 MR minimum.
• The policy pet matches the record details: Name, breed, color (cats especially), age, owner, etc.

• The task due date is set and assigned appropriately to the MRR team.
• Off-protocol submissions are documented accessibly for MRR (example: Furry Friends does not write SOAPs, only line items possible to obtain).

• Claim investigation guidelines indicate an MRR is warranted.
• Claim is not already known to be ineligible for coverage.

Click the "emergency stop" below for more information about when NOT to MRR

We cannot stress enough how much more efficient it is to take a few minutes and verify! Example of how this can help everyone: If you're reviewing a file to label it and discover multiple vets SOAPs in one PDF, you can then label it correctly-But also, by taking this step to check the file you're not requesting records that we received. This can potentially save Claim Advocates, TTEC, and the Pet Specialist time and energy tracking down something we already had and eliminate Policyholder frustration.

Medical Records for MRR - Investigating before Submitting to MRR

Investigating Medical Record Completeness

Some claims are super straightforward and simple with only one vet ever involved with a pet, and all medical records clearly uploaded and available. But, others require more detective work. Beyond reviewing the pet medical history tab and confirming the amount of vets reported at sign up, where else can we extrapolate information? Click each step on the right to learn about how you can confirm medical records are complete for MRR submission. ➜ These quick checks pave the way for your claim to move seamlessly through the Medical Record Review process. Remember, these may not all be needed dependent on each claim.

Check the Medical Record Completeness Indicator: Is there anything included in an "incomplete" reason that we need to obtain?

If applicable, use the Medical Record Validation Tool. Is there a flag indicating we DON'T have everything we need?

Check prior settled Claims-Are there invoices for vet hospitals we don't have medical records for, and is there reason to believe the pet went there prior to the illness waiting period end?

Investigate the Medical Records you do have! If they've been going there less than 12 months prior to the PED-Does the first visit name a prior vet? Include anything like "This is the first vet he's been to since we had him" in the subjective?

Medical Records for MRR - Types of Incomplete Medical Records

Identifying Incomplete Medical Records

Before we submit a claim for MRR, we should always open all documents and confirm they are complete medical records. Sometimes this is straightforward, and sometimes this can be tricky! Read on for some examples of incomplete records that can be missed and submitted incorrectly for MRR. Incomplete, partial SOAP notes:

• The DVM wasn't done writing the record but what IS complete is sent. Can be only line items or just SOME information, make sure the entire SOAP is there and not just "SO".
• The person exporting the record at the clinic exported it without key elements checked off to show-Labwork, client communications, prescriptions, etc.

Devil-in-the-Detail Non-SOAP Documents:

• Detailed Discharge Summaries: These can include some medical information and almost look like a proper MR. We still need to re-request the record in the format they would send to another vet clinic.
• Policyholder Submitted MRs: Sometimes the vet clinic will omit pertinent internal notes when sending MRs direct to the policyholder, thinking they don't need that level of detail (and not just removing the *warning: spicy client* banner!).
• Let's take a look at the impact of having those correct and full medical records before MRR Submission - click the card to the right to learn more!

Importance of Complete Medical Records

Medical Records for MRR - Records not needed for MRR

Which records do we *not* obtain?

Specifics on wellness treatments and Vaccine-Only Clinics: If we have an invoice showing only vaccines from a wellness-only service like a pop-up Wellness Clinic within a pet store, we don't need further info. Why? The exams performed at this type of clinic are just confirming the pet is healthy to receive vaccines, they aren't comprehensive and the pet being there implies it was a healthy visit.

Previous Owner, Rescues, and Humane Society Records: If the PH does not send these in to us directly, we will not retrieve them from a third party. Why? While they're nice information to have, obtaining records from the pet’s vet should provide an accurate health history including any previous issues. When do we need these records? We often see a note in MRs like “owner brought adoption paperwork” or “prior medical history emailed”-We should pursue the missing attachment by contacting the vet hospital that documented having it.

Emergency Medical Records when the diagnosis is known: If the conditon is documented with their regular vet, we can use that and not reach out to the ER. Why? We don’t have anything to gain by obtaining medical records when we already know what happened. When do we need these records? If we only have a vague idea of why they went to the ER, there's indication of a history of visits we don't have context for aside from that one, or we have other visits on file for any other vet during the same time period that are not documented in the main MR.

Thank you, that's all!

Back to home

Claims that should NOT be sent to MRR:

• Claims where only direct policy exclusions were claimed.
• Claims where it's a condition within the waiting period for the type of condition, regardless of any records being on file (If you need tips on how to write the denial, ask your Lead or an experienced Claim Advo on your squad for help!)
• Claims where in your verification of the records on file, you gathered information that the condition is pre-existing.

Real talk-During a busy season when claim inventory is high and you're feeling overwhelmed, it could be tempting to get some rapid relief by generating unnecessary MRRs:

Triage so quickly you miss denial opportunities, send claims for MRR to write a med timeline for a known PEC, or send claims you can settle to MRR to give yourself time to triage other claims. Please only send MRRs that are needed and reach out to your Lead instead to get the support you need. If your inventory is high, it's high for MRR too. Just like your workload is based the amount of manual claims we receive, their team's workload capacity is based on the percentage of claims that need MRRs. Frivilous MRR submissions hurt their ability to perform MRRs that really are needed, which gives our policyholders a worse experience, and Pet Specialists will also feel that policyholder frustration toward them-it affects everyone!

Pre-screening the medical records to ensure they're complete allows for efficient and effective claim resolution, which is the goal for everyone across all teams to deliver for our policyholders. Quality checking medical records shows you respect the task you're requesting MRR Associates to perform and their time, allows all medical record reviews to come back to you faster, and creates a faster MST and therefore a better experience for the policyholder. Win, win, and win!