Why Responding to Records Requests Matters

Our primary commitment to you is to provide your practice with the tools and support to help it thrive and grow. That’s why when you submit a claim, you get paid without having to jump through prepayment review hoops. We understand that quickly processing claims and payments ensures that you can cover your practice’s operating costs, including payroll and supplies, and it reduces the administrative burden placed on your staff. While we don’t usually require prepayment reviews, we do require a prompt response to records requests. Unfortunately, we do not always receive responses to our requests.

Because we don’t do prepayment reviews, we are required by federal law to conduct utilization reviews. These reviews are not punitive — they’re a standard process that ensures that the care provided to our members is clinically appropriate, that billing is accurate, and that the documentation submitted supports the services provided. Practices are selected randomly for review, and the process is designed to be as smooth and respectful as possible.

Not responding to these requests puts your practice at risk

There can be serious impacts and consequences when we don’t receive complete records. These can include:

• Requiring prepayment reviews for all future claims

• Reporting noncompliance to state or federal agencies

• Removal from our network

We depend on your timely response to these requests. When that doesn’t happen, we are obligated — legally and ethically — to take the necessary action to ensure that the care provided to our members meets accepted standards and is accurately billed.

What you need to do

• Respond promptly to any records request

• Ensure documentation is complete and legible

• Reach out if you need help understanding what’s required

Let’s work together to maintain the integrity of our network, so that we can continue offering a streamlined, trust-based claims process that benefits everyone.

Our team is always available to clarify expectations and support your compliance efforts. If you have any questions, please reach out to clinicalreviews@fclife.com.

Thank you for your partnership and for doing your part to ensure that our members — your patients — continue to get the essential dental care your practice provides.