BlueCard^® connection: reducing the number of medical record requests

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

Can I reduce the number of medical record requests I receive for BlueCard claims?

Yes. You should verify eligibility, benefits and authorization requirements before the service is rendered. Doing this will confirm that:

• The member’s coverage is active for the date of service
• The service is covered under the member’s contract

Obtaining a required authorization may not only prevent a denial, but it may also eliminate the need for the plan to request additional supporting information to determine whether the claim can be paid.

Keep the following steps in mind:

• Always verify the member’s eligibility and benefits.

• Verify and obtain a required authorization, or request pre-approval for services prior to treatment. When rendering a treatment or therapy that recurs over a period of time, contact the out-of-state plan to request pre-approval for the expected treatment plan. Recurring treatments or therapies include chemotherapy, radiation treatments and physical and speech therapy.

• Use the medical policy, pre-authorization and pre-certification router to determine an out-of-state Blue plan’s medical policies and general authorization requirements. The router is available on bcbsm.com, Provider Secured Services and web-DENIS. You can also find a link to the router in the "BlueCard" chapter of every online provider manual.
  
  Note: Never apply Blue Cross Blue Shield of Michigan’s medical and benefit policies to BlueCard claims. Each Blue plan’s policy will be different.

For more information on the BlueCard program, including links and articles on online tools, reference the BlueCard chapter of the online provider manuals.

If you’re experiencing issues with the information provided in the BlueCard chapter of the online provider manuals 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 ProvComm@bcbsm.com and put “BlueCard series” in the subject line.