Blue Cross Blue Shield of North Dakota (BCBSND) has received provider feedback regarding inconsistencies in receiving medical records requests to the appropriate location. With further research, we discovered several issues and will be making the following change to ensure you receive requests.
If medical records are needed, you will receive a denial with reason code CO252 and remark code M127: “Missing patient medical records for this service.” This will generate a letter requesting the specific medical records needed to process the claim. The letter will be sent to the mailing address we have on file. A member Explanation of Benefits (EOB) will also generate; however, the EOB is only available electronically and will not be mailed to the member. Upon receiving the requested records, the claim will process accordingly.
As an additional measure to improve the efficiency with this process, effective October 1, BCBSND does not review unsolicited medical records received from participating providers. Medical records must be sent in with one of the following:
- The letter BCBSND sent to request the records
- Medical Records Submission Form/Cover Sheet (located on the BCBSND provider website)
BCBSND is unable to identify the purpose for the records submission in the absence of one of the forms listed above (excluding records for utilization management). By using one of the above documents, the medical records can easily be tied to the applicable claim. This will help improve our timeliness with processing these requests.
HealthCare News Blast | September 24, 2019