Livanta BFCC-QIO Record Request
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Record Requests

Instructions

There are two ways to obtain a copy of the medical records that Livanta used to makes its decision. The best way is for the Medicare patient, or an authorized representative, to get the records directly from the original provider of services (hospital, skilled nursing facility, physician practice, etc.). This is usually the least expensive method, especially if the requestor can pick them up. The second way is to request them from Livanta after Livanta has made a decision on the case. Also, if the case is being appealed beyond the Livanta level, the medical records may be available at that further appeal level.

Note: we can usually only supply copies of the actual medical records; we cannot send copies of our notes, workpapers, or drafts of letters, and we can only send information that identifies practitioners if the case is appealed beyond the Livanta level.

To make a request for medical records from Livanta, you must send a signed request that includes:

  1. The beneficiary’s name

  2. The case number or the beneficiary’s Medicare number

  3. A listing or description of what is being requested

  4. A statement indicating whether the case has been or will be appealed beyond the Livanta level

  5. The name and address where the records should be sent

  6. An email address or fax number for faster notification (optional)

  7. If the request is signed by the beneficiary, it must be accompanied by a copy of a photo ID, such as a driver’s license

  8. If the request is signed by an authorized representative, it must be accompanied by proof of authorization, such as a completed Form CMS-1696 or an official authorization document

Fax the written request and proof of identify to 301-490-1339, or mail them to:

BFCC-QIO Area 1
Medical Records Request
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701-1105

Livanta will locate the records, compute the cost to send them, and notify you of the cost and where to mail the check (not the same address as above). Costs generally include retrieval from storage, printing or copying, packaging in tamper-resistant packaging, and mailing by Express Mail for security purposes. The cost is generally between $40 and $100.

Once we receive the check, the records will be mailed.
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