Notice: Request for and Provision of Medical Records

Date: 05/13/22

As a reminder, Medicaid claim payment for services rendered also includes reimbursement for any function incidental to the provision of a covered service. These include providing a copy of the Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) member’s medical record requested by the member, member’s legally authorized representative, or another provider. This is outlined in the Texas Administrative Code, 1 TAC §354.1005, Unauthorized Charges provision.

If a provider receives a request for medical records, but has previously supplied the member/member’s representative with a free copy of the medical record within a one year period, only the amended, supplemented, or corrected portion of the record must be supplied. Providers are not required to re-administer the entire record.

If additional medical records are requested within a one year period, a provider may charge a member/member’s representative a “reasonable fee” of no more than $25.00 for the first twenty pages and $.50 per page for records exceeding twenty pages, as allowed in the Texas Administrative Code, 22 TAC §165.2, Medical Record Release and Charges provision.

If you have any questions about these guidelines, please Contact Your Local Account Manager.