How Claims Adjusters Can Speed Up Medical Record-Based Claims Decisions

Key Takeaways

• Medical Record-Based Claims slow down when documentation is delayed, incomplete, or poorly organized.
• Claims adjusters need proactive record retrieval, not passive submission tracking.
• Clear authorizations, defined record scopes, and provider follow-up dramatically reduce turnaround times.
• Digital visibility and centralized tracking eliminate internal bottlenecks.
• Record Retrieval Solutions (RRS) helps claims adjusters reduce delays, with a 15-day average turnaround time.

Medical record-based claims are often the longest part of the claims lifecycle, and not because adjusters are slow.

The delay usually starts upstream: incomplete authorizations, provider backlog, copy-service fees, and poor visibility into status. When medical documentation stalls, claims adjusters absorb the pressure. Cycle time increases. Claimants follow up. Supervisors escalate.

But speed is possible.

Here’s how claims adjusters can shorten medical record-based claims without sacrificing compliance or accuracy.

Why Do Medical Record-Based Claims Decisions Get Delayed?

Before improving speed, we need to identify the real bottlenecks.

Passive Record Submission

Many workflows rely on simply submitting a request and waiting. Providers prioritize clinical care first. If no one follows up, your request sits in the queue.

RRS changes this dynamic. Instead of “submit and wait,” RRS uses dedicated provider outreach with direct communication with facilities until records are secured.

Incomplete or Incorrect Authorizations

A single missing signature or date resets the clock. That means days—or weeks—lost.

Claims adjusters often juggle high caseloads. Reviewing every authorization line-by-line becomes unrealistic.

RRS reviews authorizations before submission, catching errors early and preventing requests from being rejected.

Copy Service Delays and Fees

Many facilities outsource records to third-party copy services. These vendors often add processing time and additional charges.

Without oversight, requests stall in copy-service queues.

RRS proactively communicates with providers and copy services to confirm release requirements and exhaust no-cost options before escalating.

No Visibility Into Status

When adjusters lack real-time updates, they:

• Send duplicate follow-ups
• Escalate prematurely
• Miss critical status changes

RRS centralizes every order in a digital portal, giving adjusters full visibility without email chains or phone tag.

How Can Claims Adjusters Speed Up Medical Record-Based Claims?

Start With a Defined Record Scope

Over-requesting slows everything down.

Instead of requesting “complete medical records,” define:

• Date ranges
• Specific body parts
• Type of visit (emergency room, physical therapy, imaging, etc.)

A targeted scope reduces provider workload and accelerates release.

RRS helps adjusters clarify record scope before submission, reducing back-and-forth.

Validate Authorizations Before Submission

Medical Record-Based Claims hinge on valid authorization forms.

Before submission, confirm:

• Correct patient information
• Accurate provider name
• Signature and date
• Expiration compliance

RRS performs pre-submission quality checks to prevent rejections.

Use Proactive Provider Outreach

Speed is rarely about sending more emails. It is about consistent follow-up.

RRS communicates directly with:

• Medical records departments
• Health Information Management (HIM) teams (the department responsible for maintaining patient records)
• Copy services

Instead of waiting for providers to respond, RRS tracks, follows up, escalates when needed, and logs deficiencies.

Centralized Tracking and Chain of Custody

Chain of custody refers to documented tracking of records from request to receipt, ensuring security and compliance.

When tracking is fragmented across spreadsheets and inboxes, delays multiply.

RRS provides centralized order tracking, allowing claims adjusters to:

• View status in real time
• Access uploaded records instantly
• Track provider responsiveness
• Monitor turnaround time trends

Visibility reduces internal bottlenecks and supports faster decision-making.

What Role Does Turnaround Time Play in Claims Outcomes?

Turnaround time directly affects:

• Claim cycle time
• Reserve accuracy (the projected amount set aside to pay a claim)
• Customer satisfaction
• Litigation risk

If documentation takes 30–45 days, medical record-based claims sit idle. That affects financial forecasting and operational performance.

RRS maintains a 15-day average turnaround, with faster timelines for select projects. That speed allows adjusters to:

• Review documentation sooner
• Make liability and damages decisions faster
• Close files more efficiently

Speed is not just convenience. It is operational leverage.

How Can Claims Adjusters Reduce Internal Friction?

Even when records arrive quickly, internal friction can slow decisions.

Organize Records for Faster Review

Disorganized medical files create review fatigue.

RRS offers optional Optical Character Recognition (OCR), which converts scanned documents into searchable text. This allows adjusters to search keywords such as:

• Diagnosis
• Procedure
• Treatment date

Searchability reduces review time and supports faster Medical Record-Based Claims decisions.

Eliminate Duplicate Requests

Duplicate requests waste provider goodwill and create confusion.

With centralized tracking, RRS ensures that each provider receives a single, clearly defined request with documented follow-up.

Standardize Workflow

Consistency matters.

When adjusters follow different processes, delays increase.

RRS supports standardized intake processes for insurance carriers and third-party administrators. This creates predictability and measurable performance metrics.

Where Are the Growth Opportunities for Claims Adjusters?

Medical Record-Based Claims are expanding across:

• Disability claims
• Workers’ compensation
• Property and casualty (P&C) claims
• Life sciences documentation support

As documentation demands increase, manual workflows cannot scale.

Partnering with a retrieval company like RRS allows claims departments to scale without increasing headcount.

Instead of hiring additional staff to chase providers, adjusters can redirect time toward analysis, negotiation, and resolution.

What Makes RRS Different for Claims Adjusters?

Many vendors simply submit requests.

RRS operates as an extension of your claims team.

Here is what that means:

• Dedicated provider outreach
• Authorization review before submission
• Real-time portal visibility
• Chain-of-custody documentation
• Average 15-day turnaround
• Escalation tracking and deficiency logging

RRS does not “enforce” provider compliance. Instead, we monitor, appropriately escalate, and track updates to ensure forward progress.

That distinction matters for compliance accuracy and partnership alignment.

A Practical Workflow for Faster Medical Record-Based Claims

Here is a simplified framework that claims adjusters can implement immediately:

1. Define record scope precisely.
2. Validate authorization before submission.
3. Submit through a centralized retrieval partner.
4. Monitor status through a digital portal.
5. Review searchable records upon receipt.
6. Make timely liability and damages determinations.

When RRS supports this workflow, delays caused by provider backlog and internal miscommunication decrease significantly.

Conclusion

Claims adjusters are measured by speed, accuracy, and fairness.

Medical record-based claims should not be the unpredictable variable in that equation.

By tightening record scope, validating authorizations, leveraging proactive provider outreach, and centralizing tracking, claims adjusters can dramatically shorten decision timelines.

RRS enables that transformation.

With dedicated outreach, full chain-of-custody documentation, and a 15-day average turnaround, RRS helps claims departments move from reactive to proactive.

If your medical record-based claims are stalling, it may not be your team’s fault. It may be your retrieval process.

Book a demo or contact us today.

FAQs