Attorney Requests

We understand that patients may turn to the courts after an accident, and Mediserv LTD has assembled a team to assist law firms and record retrieval companies in securing the documents needed to further a legal claim. We are a billing company and, as such, can provide copies of patient statements as well as execute affidavits and depositions related to ER physician billing. However, we do not store and cannot provide copies of medical records. Any request for medical records, films, etc. should be directed to the hospital at which your client was treated.

ASSEMBLING THE PAPERWORK

If your firm requires a document from us, please compile the following information on a medical authorization that is signed by the patient and dated:

  • the name of the ER doctor’s group
  • the date(s) of service
  • your client’s date of birth and the last four digits of his / her social security number

If your firm does not have a HIPAA-compliant medical release, Mediserv has made a form available. You may access and download the document here.

Please note that your medical release needs to be addressed to the specific doctor’s group, not the name of the hospital or Mediserv LTD.

SUBMITTING YOUR REQUEST / RECEIVING DOCUMENTS

Once you have assembled the required documents (medical release and, if required, affidavit), please electronically transmit your request to us via ChartSwap. The postal service has become an increasingly unreliable method of delivery and, because of that, Mediserv has partnered with ChartSwap, a web utility that allows us to exchange billing documents, affidavits, etc. via the Internet. You may access an existing account or create a new account at ChartSwap.

ChartSwap

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We understand that, in some cases, original copies of an affidavit or deposition are required for filings. For any document that requires a notarial citation, your law firm may choose from a series of delivery options: electronic delivery, delivery by mail, or both. When initially submitting your request, choose the appropriate delivery method, and we will charge you accordingly. (Know that if you choose delivery by mail, Mediserv is not responsible if the document is lost between our office and yours.)

PAYING FOR THE DOCUMENTS

Before we work your request, Mediserv will invoice your firm. Our fees vary based on the complexity of the request and individual state law. Upon electronically receiving the invoice, you may pay on the ChartSwap website with your credit card or e-check. Or, you may draft and mail a check to us. Either option is fine, and the instructions and address for mailing a check are printed on the invoice.

To review our fees, please select the state where the patient received care from the list below:

Arkansas

  • $15.50 for billing record requests*
  • (There is an additional charge beginning at $.50 per page for requests of more than three pages.)
  • $6 for any document requiring a notarial citation (per citation)*
  • $10 to complete balance verification form (with or without notarial citation)*
  • $50 for deposition or cross questions and billing records (includes notary fee)*

*There is an additional fee for expedited requests (any request that must be completed within four business days).

Colorado

  • $16.50 for billing record requests*
  • (There is an additional charge beginning at $.75 per page for requests of more than ten pages.)
  • $6 for any document requiring a notarial citation (per citation)*
  • $10 to complete balance verification form (with or without notarial citation)*
  • $50 for deposition or cross questions and billing records (includes notary fee)*

*There is an additional fee for expedited requests (any request that must be completed within four business days).

Florida

  • $1.00 per page for the first 25 pages of billing records, and $.25 per page for every page thereafter*
  • $6 for any document requiring a notarial citation (per citation)*
  • $50 for deposition or cross questions and billing records (includes notary fee)*

*There is an additional fee for expedited requests (any request that must be completed within four business days).

Illinois

  • $27.37 for billing record requests*
  • (There is an additional charge beginning at $.99 per page for requests of more than three pages.)
  • $6 for any document requiring a notarial citation (per citation)*
  • $10 to complete balance verification form (with or without notarial citation)*
  • $50 for deposition or cross questions and billing records (includes notary fee)*

*There is an additional fee for expedited requests (any request that must be completed within four business days).

Iowa

  • $20 for billing record requests*
  • (There is an additional charge beginning at $1 per page for requests of more than 20 pages.)
  • $6 for any document requiring a notarial citation (per citation)*
  • $10 to complete balance verification form (with or without notarial citation)*
  • $50 for deposition or cross questions and billing records (includes notary fee)*

*There is an additional fee for expedited requests (any request that must be completed within four business days).

Kansas

  • $19.60 for billing record requests*
  • (There is an additional charge beginning at $.63 per page for requests of more than three pages.)
  • $6 for any document requiring a notarial citation*
  • $10 to complete balance verification form (with or without notarial citation)*
  • $50 for deposition or cross questions and billing records (includes notary fee)*

*There is an additional fee for expedited requests (any request that must be completed within four business days).

Texas

  • $25 for billing record requests*
  • (There is an additional charge of $.50 per page for requests of more than 20 pages.)
  • $15 for affidavit or revised affidavit requests*
  • $10 to complete balance verification form (with or without notarial citation)*
  • $50 for deposition or cross questions and billing records (includes notary fee)*

*There is an additional fee for expedited requests (any request that must be completed within four business days).

FAQs

Why do we have to use ChartSwap?

Every year, we have 24-25 worked requests that never make it back to the law firm. In addition, we receive phone calls about requests that never made it to our office. Using the web allows us to bypass the postal system, making the request process faster and more reliable.

Do we have to use your Medical Authorization? And, if so, why?

No, you may use your own release as long as it provides the same general information as ours. Again, your release must include basic patient information (e.g., SSN, date of birth and known aliases), date(s) of service, and facility name. The form must be signed and dated. Finally, if someone other than the patient signs the medical release, the legal relationship between the patient and signer must be defined. Plus, you should include appropriate legal paperwork, such as a POA, with your request.

Why does it take as long as 15 days to fulfill a request?

Most billing requests are worked in 3-4 days. However, we receive 300-400 requests each week. Considering the type of sensitive data that we are providing, a volume of that magnitude requires careful processing. In addition, much of what we return to you requires a notarial citation. For that reason, we ask that you do not contact us for a status update within the 15-day window.

Why will you not accept faxed or e-mailed requests?

Every request made of us contains sensitive information about your client. Neither delivery method (fax or e-mail) is entirely secure. Your request must be sent through the ChartSwap website.

Why will you not provide periodic status reports?

If we answered every request for status, we would get little else done. Know that we are required by state law to respond to your request in an appropriate amount of time (e.g., 15 days in Texas), and we will work your request in that time period.