Blue Cross Blue Shield of North Dakota (BCBSND) wants to remind providers of the medical record submission process.
BCBSND will not review medical records received from participating providers if the medical records are sent without one of the following:
- The BCBSND medical record request letter
- The Medical record submission form located on the BCBSND provider website
Medical records submitted without one of the above, will be considered unsolicited. This may also include records received with the wrong member or claim information supplied. Unsolicited records will not be reviewed and will purge from the BCBSND system after 180 days.
If the above process is followed, but there is not enough information to make a determination, you may receive another request for additional documentation, please follow the same process when submitting additional requested records. If the claim denies for lack of supporting documentation, you will receive notification on your remittance and will need to proceed with appropriate next steps, such as an appeal if applicable.
Exceptions that may apply to the above process:
- Utilization Management (UM) precertification/authorization requests from providers.
- UM will allow standard cover pages for records required for these types of submissions.
- Payment Integrity Program record requests
- You can visit the Payment Integrity Program webpage for more information.
If you want to check the status of medical records, you can utilize the direct messaging feature of the Availity Essentials portal or contact the Provider Services phone number found on the back of the members ID card.
