Accelerating Medical
Record Retrieval for
Payment Integrity

Overview

Manual Record
Retrieval Was a Hidden
Operational Bottleneck

For a top-five national health plan, payment integrity investigations were slowed by delays in medical record retrieval. Requests were sent manually, responses arrived through mail, and investigators had little visibility into provider response timelines.
 
Commence modernized the process by automating electronic medical record outreach and retrieval—reducing retrieval times by 72% and enabling faster clinical review across the health plan’s SIU workflow.

Problem

A 45-Day Wait for Answers

Before Commence, the health plan’s medical record retrieval process relied on manual outreach and mailed responses. The average wait time for records reached 45 days, with no consistent tracking of provider response rates or request status.
 
These delays slowed fraud investigations, extended case timelines, and limited the organization’s ability to quickly validate claims or pursue recoveries.

Solution

Automated Medical
Record Retrieval

Commence implemented an automated outreach and retrieval workflow designed to accelerate medical record access for payment integrity investigations. Providers received structured digital requests and automated follow-ups, while investigators gained full visibility into request status and response activity.
 
Secure electronic submission through a provider portal replaced mailed records—enabling faster retrieval and scalable workflows across the health plan’s provider network.

Impact

Faster Record Retrieval.
Stronger Payment Integrity.

The pilot processed 1,671 medical record requests and successfully retrieved 1,291 records, delivering an 84% retrieval rate for payment integrity investigations.
 
Average response time dropped from 45 days to 12 days, accelerating medical record retrieval by 72% and allowing investigators to move cases forward faster.
 
As portal adoption increased from 39% to 95%, electronic submissions became the primary method of retrieval, further reducing delays and improving visibility across the investigation process.