Medical Record Routing Form - Instructions & Info
The Medical Record Routing Form is essential for submitting required documentation for a previously submitted claim or linking documentation to an electronically submitted claim. This guide offers detailed instructions to ensure your submission is accurate and timely. Follow the provided guidelines to avoid any delays in processing your claims.
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How do I fill this out?
To fill out the Medical Record Routing Form, begin by completing it online. Ensure all information is accurate before printing the form. Once completed, submit it as instructed below.
How to fill out the Medical Record Routing Form - Instructions & Info?
1
Complete the form online and do not handwrite it.
2
Select the reason for sending documentation.
3
Enter the required claim information.
4
Fax or mail the printed form and documentation.
5
Ensure all claim information matches original electronic claims.
Who needs the Medical Record Routing Form - Instructions & Info?
1
Healthcare providers submitting additional documentation for claims.
2
Patients needing to link medical records to claims.
3
Insurance clerks processing claims for reimbursement.
4
Billing departments requiring clarification on claims.
5
Any entity that has received a request for medical records.
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Upload your PDF file to PrintFriendly.
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Select the sections you want to edit.
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Make your edits using the provided tools.
4
Review the changes to ensure accuracy.
5
Download the edited file for your records.
What are the instructions for submitting this form?
To submit the Medical Record Routing Form, fax it to BCBSM Medical Records at 1-866-617-9917 for documents under 100 pages. If your documentation exceeds 100 pages, please mail it to: Blue Cross Blue Shield of Michigan, PO BOX 166, Detroit, MI 48231-0166. Ensure that only the requested documentation is included and review the information for accuracy prior to submission.
What are the important dates for this form in 2024 and 2025?
Important dates for the Medical Record Routing Form include submission deadlines, which vary based on specific claims processing. Ensure to check with your insurance provider for exact timelines in 2024 and 2025 to avoid any processing delays.
What is the purpose of this form?
The purpose of the Medical Record Routing Form is to facilitate the submission of required medical documentation associated with health insurance claims. This ensures that any missing or required information is provided to avoid delays in claims processing. By using this form, healthcare providers and patients can effectively communicate necessary details to improve claim outcomes.
Tell me about this form and its components and fields line-by-line.
- 1. Patient first name: The first name of the patient for whom the claim is being submitted.
- 2. Subscriber last name: The last name of the insurance subscriber.
- 3. Contract number: The health insurance contract number associated with the patient.
- 4. SCCF number: The SCCF number associated with the claim, required for BlueCard medical reviews.
- 5. ICN/Claim number: The identification number of the claim for previously paid or denied claims.
- 6. Date of service: The date when the service was provided to the patient.
- 7. Billing NPI: The National Provider Identifier of the billing healthcare provider.
- 8. Patient control number: The patient's account number or claim number in the billing system.
- 9. Attachment control number: A document identification number for billing; should differ from patient control number.
- 10. Brief reason for review request: A short explanation indicating why this form is being submitted.
What happens if I fail to submit this form?
Failing to submit the Medical Record Routing Form may result in delays or denials of claims. It's crucial to ensure that all required documentation is submitted with the form to avoid these issues.
- Claim Denial: If the form is not submitted, your claim may be immediately denied, leading to financial implications.
- Processing Delays: Missing documents can cause significant delays in the review and processing of your claims.
- Additional Requests: Failure to include the proper form may lead to further requests for documentation, increasing workload.
How do I know when to use this form?
- 1. Review of Previous Claims: Submitting documentation to support previously paid or denied claims.
- 2. Linking Documentation: Connecting supplementary documentation to newly submitted electronic claims.
- 3. Responding to Requests: Providing the required medical records as requested by an insurance company.
- 4. BlueCard Submissions: Submitting medical records for claims involving BlueCard rejection requests.
- 5. Claim Disputes: Filing disputes through additional documentation as needed.
Frequently Asked Questions
How do I fill out the Medical Record Routing Form?
Complete the form online, ensuring all fields are filled accurately. Print the form and prepare it for submission.
What types of claims can I link to this form?
You can link the form to original electronic claims or previously paid or denied claims requiring additional documentation.
How do I submit this form?
The form can be faxed or mailed based on the number of pages. Fax it to BCBSM Medical Records for documents 100 pages or less.
What should I include with this form?
Attach only the requested documents specified in the claim denial or inquiry letter.
How long does it take to process my submission?
Allow a minimum of 30 days for the review of the submitted documents.
Is there a specific order for the documents?
There is no required order, but ensure all necessary documents are included for your submission.
Can I edit the form after printing?
Yes, you can use PrintFriendly to edit the PDF file before printing it.
What if I have questions about my claim?
Contact Provider Inquiry or your provider consultant for assistance regarding your claim.
Can I submit this form and a claim form together?
No, do not attach a copy of the claim form when sending this form.
How do I know if I need this form?
Use this form if you need to submit additional documentation for a claim or if requested by your insurance provider.
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