Continuity of Care documents provide adjusters with a brief and concise high-level overview of past medical conditions and treatments in a standardized format, enhancing the review of handwritten physician notes, which often can be difficult to decipher. Information included in a Continuity of Care document can help indicate whether an injury or other condition predates the claim or not and can help an adjuster determine if a record request or medical canvass is necessary.
For example, if a person is in a minor car accident and claims to have a neck injury as a result, the Continuity of Care document may reveal whether this person has previously undergone treatment for neck pain. If previous treatment appears, the adjuster knows that more information is needed before proceeding with the claimant’s demand and can then submit record requests.
Conversely, a Continuity of Care document can also help validate a claim. Using the previous example of neck pain, a C-CDA may reveal that the claimant does not have a history of neck pain, therefore the adjuster can potentially move forward with responding to the demand without need of additional information.
Continuity of Care documents are a critical tool for simplifying insurance investigations and settlement negotiations.
