Claim attachment enhancement effective Aug. 5

Starting Aug. 5, 2016, Blue Cross Blue Shield of Michigan will be able to systematically link faxed or mailed required additional documentation to a corresponding professional or institutional electronic claim.

We’re making this enhancement to:

• Improve claims processing for services that always require documentation.
• Prepare for the anticipated federal electronic claim attachment mandate.

Note: Blue Care Network, Federal Employee Program^®, Medicare Advantage and BlueCard^® claims are excluded from these changes. However, FEP will use the Medical Record Routing Form.

We’ve shared information about this enhanced process with you over the past couple of months through Record articles in December and May, provider informational forums, Michigan Hospital Networking quarterly meetings and Benefit Action Committee meetings. Here are some of the most commonly asked questions at these meetings:

Frequently asked questions

What is a claim attachment?
A claim attachment is additional documentation (for example, medical records) required by Blue Cross when the supporting medical records are required to determine if the service reported is a covered benefit of the patient’s contract.

How will we know which services always require additional documentation?
The May 2016 Record article on the claim attachment enhancement included a list of services that always require supporting documentation and this list of services will be added to the Claims section of the Blue Cross online provider manuals on Aug. 5, 2016.

What are the electronic requirements to ensure that the required additional documentation is linked to the electronic claim?
The PWK segment (paperwork segment) of the electronic claim (837 transaction) must indicate that medical records are being sent by fax or mail. If the PWK segment doesn’t indicate that additional documentation is being sent — and supporting documentation is required — the service will automatically be rejected for the required documentation.

How do I send the required additional information (medical records) to Blue Cross if I'm reporting the claim electronically?
Attach the medical records to the updated Medical Record Routing Form, which will be posted on the new Forms page on web-DENIS on Aug. 5. Click on the appropriate button at the top of the form to indicate whether the documentation submission relates to a “previously paid or denied claim” or an original electronic claim. Complete the form as required (information regarding completing the form can be found on the first page), print it and use the form as the cover sheet to fax the records to Blue Cross.

How quickly should I send in the required medical records after releasing the electronic claim?
The required additional documentation must be received within seven calendar days of the electronic claim receipt. Release the claim and complete, print and fax the completed Medical Record Routing Form, along with the required medical records totaling 100 pages or less, to 1-866-617-9917. If the medical record documentation totals more than 100 pages, mail the completed routing form and the documentation to the address on the bottom of the form.

What happens when Blue Cross requires additional documentation and the electronic claim doesn't indicate documentation is being sent?
When a service requires additional documentation and the electronic claim doesn't indicate that additional documentation is being sent (by completing the PWK segment), the service will automatically reject, requesting the additional information.

What will occur when Blue Cross requires additional documentation and the faxed or mailed Medical Record Routing Form is not accurately completed (for example, the form is handwritten or the information on the medical record routing form doesn't match the information submitted on the electronic claim)?
In order to link the documentation to the electronic claim, the system must be able to match the following medical record routing data fields with the data submitted on the electronic claim: patient first name, subscriber last name, contract number, date of service and billing NPI. If these data fields are not legible on the Medical Record Routing Form or the data on the form (e.g., contract number, patient first name, subscriber last name, date of service) is different from what was submitted on the electronic claim, linkage can't occur and the service will automatically reject, requesting the additional information.

Can I use the Medical Record Routing Form to submit medical records on a rejected claim?
Yes. In a July 2016 Record article, we explained how the Medical Record Routing Form should be used as a cover sheet when sending supporting medical records to request review of a rejected claim. After the claims attachment enhancement starts on Aug. 5, you’ll choose the appropriate button to indicate the reason the documentation is being sent (e.g., a “previously paid or denied claim” or an “original electronic claim”).

Where can I find additional information regarding how to link documentation to a claim?
Blue Cross offers an online provider training resource through web-DENIS. You can find the resource by following these steps:

• Go to BCBSM Provider Publications and Resources.
• Click on Newsletters and Resources.
• Click on Provider Training.
• Choose the Claim Attachment Process.