Agencies aren’t responding to medical review requests, leading to easy denials, according to the latest data from Palmetto GBA on medical review denials for the last three months of 2025.
More than one out of every three denials, 35%, was attributed to the requested records not being submitted.
“No plan of care or certification” and “face-to-face encounter requirements not met” were at No. 2 and No. 3.
The top five were:
- Auto Denial, Requested Records Not Submitted: 35%
- No Plan of Care or Certification: 22%
- Face-to-Face Encounter Requirements Not Met: 18%
- Information Provided Does Not Support Medical Necessity for this Service: 10%
- Visits/Supplies/DME Billed Not Documented/Not Documented As Used: 2.7%