Don’t send medical records requested by Optum to Blue Cross

When you receive a request for medical records from Optum, you need to send the records to Optum within 60 calendar days of the request. Sending the records to Blue Cross Blue Shield of Michigan will cause a delay in the review and processing of the claim.

We published a reminder in the October 2022 issue of The Record about edits or medical record requests from Optum for your patients with Blue Cross commercial coverage.

Optum is an independent company that contracts with Blue Cross to identify claims that require additional review. The Optum program has two components: pre-payment edits and medical record requests.

When a claim is selected for review, Optum sends a medical record request letter to the health care provider within two business days. The letter provides detailed instructions on how and where to submit your medical records and what to include with your submission. This includes:

• A list of affected claims
• An itemized list of required documents
• A page of instructions to submit through a secure internet portal or hard copy, plus a cover sheet with a bar code to identify your case number and pertinent information for Optum  

You must submit medical records to Optum within 60 calendar days of the request. Optum will review the records within 12 business days and send an outcome letter to you if the claim is denied. If the claim is approved and paid, the payment will appear on your voucher.

If Optum doesn’t receive the requested records within 60 days, the company will send a technical denial letter as final communication, and Blue Cross will be notified that Optum has closed the case.