New Service-Specific Forms for Sending Medical Records
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) accepts the upfront submission of medical records when the records document the medical necessity of certain services or supplies provided to our commercially-insured members. Providers should proactively send medical records to Blue Cross NC in advance of sending the record’s corresponding claim, whenever the claim being filed includes the reporting of a service and or diagnosis, which Blue Cross NC has placed on its website as eligible for upfront medical record submission. These services and diagnoses can be reviewed by codes and descriptions, and are available in the following online guides:
- Service Categories Most Frequently Requiring Medical Record Submissions
- Codes by Procedure Type Requiring Medical Record Submission
- ICD-10 Diagnosis Codes Associated with Revenue Code 0360 and Requiring Medical Record Submission
Proactively submitting medical records to Blue Cross NC to support the medical necessity of services supplied, as described in the online guides, helps avoid medical-necessity denials that result from Blue Cross NC not having the required medical necessity information. Information about how to submit medical records proactively to Blue Cross NC is available on our website at bcbsnc.com/providers, located under the tab labeled Medical Record Submission. Here, you will find instructions for how to proactively submit medical records, as well as the guides to help identify the service codes, service categories, and diagnosis codes, which most frequently require medical records to be supplied to Blue Cross NC.
(Please note that medical records to support services not covered within the online guides should not be sent to Blue Cross NC proactively. When medical records are needed to support services not listed in the guides, the records will be requested through a separate process.)
New Forms for Specific Service Types
New forms have been created for specific service types. These forms, when completed and submitted, do not typically require the submission of additional medical records. Completed forms will usually document all of the information necessary to ensure we have the information necessary to complete medical necessity reviews. The forms must be completed and submitted to Blue Cross NC in advance of a form’s associated claim being filed. By utilizing the forms and sending them to Blue Cross NC before submitting claims, we can complete medical necessity reviews in advance of claims being processed, and avoid unnecessary denials. This makes eligible payments arrive faster.
New forms for specific service types are available on the Forms and Documentation page, located at bcbsnc.com/providers. Form names identify the specific service types:
Post Service - Ambulance Log Form (form name revised)
Post Service - Dermatology Patch Allergy Testing Form
Post Service - Hemodialysis Treatment for ESRD Form
Post Service - Intraoperative Neurophysiologic Monitoring Form
Post Service - Nerve Fiber Density Form
Please note - these forms are only for use when sending medical necessity information on behalf of Blue Cross NC’s commercially-insured members, including members enrolled in Administrative Services Only (ASO) groups, and the North Carolina State Health Plan for Teachers and State Employees State Health Plan. Use of these forms is not intended for Blue Cross NC’s Medicare Advantage members, Federal Employee Program members, or BlueCard program members.