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PAP229

Medical Records


Provider Administrative Policy

Section
Claims Submission
Policy Date
November 2007
Status/Date
Revised/April 2013
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Medical Records

Medical records do not need to be routinely submitted with a claim, except in the following circumstance:

  • Prolonged service with direct patient contact CPT ® 99354 - 99357
  • Prolonged service without direct patient contact CPT ® 99358-99359
  • Modifier 22 or 63

If Blue Cross of Idaho determines that medical records are necessary to adjudicate any other claim, we will send a letter or fax requesting the specific records on a case-by-case basis.  Clearly mark the envelope with “Confidential – Route to Medical Review” on the outside of the envelope. This will ensure that the medical information remains confidential and we expedite it to the appropriate department.


Policy History

Date Action Reason
April 2013 Revised Added services that require medical records
July 2009 Revised "Route to" language clarified
May 2008 Revised Language clarified

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