Beginning December 1, Medical Records Can Be Submitted Upfront to Support Medical Necessity

BCBSNC recently announced plans to begin accepting the upfront submissions of medical records to help support the medical necessity of services already provided to our commercially insured members. Accepting medical records upfront represents a process change for the way BCBSNC previously handled unsolicited records. Beginning December 1, providers will be able to proactively send medical records to BCBSNC in advance of claims being processed. This will help avoid medical necessity denials, which result from BCBSNC not having required medical necessity information. This new process ONLY applies to BCBSNC’s commercially insured membership, including administrative-services only (ASO) groups and the State Health Plan. Federal Employee Program members, Blue Cross and/or Blue Shield members eligible through the BlueCard^® program, and members enrolled in BCBSNC’s Medicare Advantage plans are excluded. Before sending medical records to BCBSNC, please consider if the records are required and if the documentation will be sufficient to meet criteria for a given service. These criteria are outlined on BCBSNC’s online Medical Policies website for BCBSNC’s commercially insured members.