The Record - for physicians and other health care providers to share with their office staffs Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
April 2015

BlueCard® connection: answer to a recent question

As part of our ongoing series on the BlueCard program, here’s the answer to a question we received.

I sent medical records to Blue Cross Blue Shield of Michigan regarding a BlueCard claim. Do I need to contact Provider Inquiry to request that the medical records be reviewed by a member’s home plan? 

No. If you are sending the records to us that the plan requested on the appropriate form, the records should automatically be routed to the member’s home plan for review. However, if you are unsure what information the plan is requesting, it is important that you confirm the information the plan has requested by contacting our Provider Inquiry department. This should be done before sending us medical records or any documentation on the medical record routing form for a BlueCard rejected claim. Unsolicited medical records will not be forwarded to another Blue plan.

A detailed process for determining when to send BlueCard medical records on a pending or rejected claim is included in the BlueCard chapter of every online provider manual. If you have any questions regarding the medical record process after referencing the BlueCard chapter of the online provider manual on web-DENIS, contact your provider consultant.

Note: Records should be sent directly to the Utilization Department at the member’s home plan — not BCBSM — if the plan requires medical documentation to determine the appropriateness of an admission. This applies to:

  • Any inpatient authorization request
  • An appeal of a retro-authorization
  • An appeal of an authorization that was denied with the member’s home plan

If you’re experiencing issues with the information provided in the BlueCard chapter or any of the online tools — or if you’d like more information on a particular topic — contact your provider consultant. If you’d like to suggest a topic to be covered in a future issue of The Record, send an email to ProvCom@bcbsm.com and put "BlueCard series" in the subject line.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.