April 20, 2012
Your help in responding to Blue Cross and Blue Shield of Kansas’ (BCBSKS) medical records request within 10 days of the request is greatly appreciated.
If records are needed by the member’s Home plan, the records are requested from the provider sometimes after the claim has already paid. Generally, these requests are to insure the member benefits are administered properly with regard to situations such as pre-existing conditions. Other situations may require a claim to process as a denial until records are received from the provider.
In either situation, medical records will be needed to close the medical records request initiated by the member’s home plan.
We have heard from you on your experiences with the request process and have implemented an improved letter which outlines the reason the records are needed and the disposition of the claim. The medical records request letter is designed to be used as a fax cover sheet for faxing the records. Records should be faxed to only the fax number on the medical records request letter. This is important as there are other departments within BCBSKS that may request records and use a different fax number.
The Interplan Teleprocessing Services (ITS) Host medical records request and return process is a new performance measure that Blue Plans will be scored on beginning January 2013. BCBSKS would like to work with our providers to improve our processes as much as possible between now and January 2013. We want to hear from you as you experience the improvements outlined above. Please e-mail firstname.lastname@example.org with any further suggestions and include in the subject line “ITS Host Medical Record Process”.