Medical Canvassing

Medical Canvassing by YAPI

What is Medical Canvassing?

Medical canvassing is a service used by insurance adjusters, case managers, or attorneys to identify and verify the existence of a Workers’ Compensation claimant’s medical records. It ensures HIPAA-compliant, accurate medical history, which is critical for validating claims and can significantly impact the outcome for clients.

Purpose of Medical Canvassing

The primary goal is to gather comprehensive medical history to support or challenge a Workers’ Compensation claim. This helps determine whether a claim should be paid or denied by providing verified details about the claimant’s medical treatments.

Benefits of a Medical Canvass

A medical canvass provides valuable insights by answering key questions, such as:

• Multiple Facilities: Has the claimant sought treatment for the same injury at more than one medical facility?
• Prior Injuries: Was the claimant treated for a similar injury before reporting it to the insured?
• Unreported Treatments: Are there unreported or unknown treatments that could affect the claims process?
• Verification: Confirms dates of service and facility locations where the claimant received treatment.
These insights help ensure accurate decision-making in the claims process.

Medical Canvass Process

The process typically involves the following steps:

1. Submit a Request: Initiate the medical canvass request.
2. Review Claimant Information: Examine the claimant’s address history and determine if the search needs to cover multiple geographic areas.
3. Identify Facilities: Select the closest relevant medical facilities (e.g., hospitals, pharmacies, walk-in clinics) based on a geographical scale.
4. Collect Detailed Data: Gather information on facilities, dates of service, and physicians involved.
5. Reporting: Provide a detailed report summarizing findings.

Types of Facilities Canvassed

Medical canvass profiles can include a variety of providers, such as:

Hospitals
Pharmacies
Walk-in clinics
Other medical providers

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