If you receive unfavorable information from a provider after initial records were sent, what should you do?

Submitting all evidence, including the new information, is essential because it upholds the integrity of the claims process. In the context of direct pay and related practices, full transparency is critical to ensure that all relevant information is considered when evaluating a claim. When new, unfavorable information is received, it is necessary to present this alongside any previously submitted data so that a comprehensive picture can be formed.

This approach demonstrates a commitment to honesty and fairness, which are fundamental principles in advocacy and claims handling. By including the unfavorable information, you also mitigate potential issues related to withholding evidence, which could result in negative consequences for the claimant and impact the overall credibility of the claim process.

In the context of the other options, ignoring the new information would not be appropriate as it could lead to an incomplete understanding of the case, which may not serve the best interests of the claimant. Discussing the adverse information with the claimant is important, but it should occur in conjunction with submitting all evidence, as the ultimate responsibility involves ensuring that the decision-makers have access to all relevant facts. Only submitting favorable evidence would clearly misrepresent the situation and could undermine the chances of a fair evaluation of the claim.