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MEDICAL CANVASSING VS. RECORD RETRIEVAL
When Is It Necessary to Obtain a Patient Authorization?
By Melanie Pita, Esq. & Steven DeRossett
In the world of insurance, and as part of the discovery and
evaluation process, obtaining a medical canvass and/or medical
records may be required to uncover information about the claim.
While there are elements of each type of request that are similar,
there are many differences. This white paper aims to demonstrate
the differences between medical canvassing and record retrieval
and to distinguish how and when HIPAA applies to each.
What is a medical canvass?
A medical canvass uncovers where and when
a claimant may have received treatment.
DIFFERENCES BETWEEN MEDICAL CANVASSING
AND RECORD RETRIEVAL
A medical canvass is a survey of medical facilities in a specific
geographical area to uncover where and when a claimant may have
received treatment.
* The insurance company provides the medical canvassing
provider with the claimant's information, and the canvassing
6 SIU TODAY | SUMMER 2021
provider calls medical facilities within a specified geographic
area to determine whether or not the facility ever treated the
claimant, and if so, during what time period.
* In conducting these canvasses, the canvassing provider is
only looking for a " yes " or " no " answer from the facility as to
whether a claimant received medical treatment.
* No medical information about the claimant is exchanged
when conducting a canvass - in fact, if the answer is " no, " then
no Protected Health Information (PHI) even exists because
the individual was never treated at the facility.
* In instances where the canvassing returns a " yes " answer from
the facility, the claimant did go to the facility for treatment and
the insurance carrier may later decide to pursue obtaining the
medical records.
What is record retrieval?
Record retrieval is
the process of legally
obtaining patient records from a facility/
custodian of records.

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