January 2019
Responding to Electronic Quality and Risk Adjustment Medical Record Requests Via the Availity® Provider Portal
We want to help make it easier for providers to do business with us. Coming soon, you will be able to receive electronic quality and risk adjustment medical record requests from Blue Cross and Blue Shield of Illinois (BCBSIL) and submit the needed documentation through the Availity Provider Portal.
To receive and respond to these medical records requests, you must be registered with Availity. Once registered users log into the Availity Provider Portal, requests for these medical records will display in the Notification Center. Providers may then upload and submit medical record documentation using the "Medical Attachments" application. Providers may track and audit their submissions.
To enable this feature, administrators may log in and select:
- Enrollment Center
- Medical Attachments Setup
- And then enter the required data
BCBSIL aims to integrate new transactions and processes within providers’ daily Availity workflow. This new electronic quality and risk adjustment medical records submission capability has the potential to:
- Lessen the administrative burden and inconveniences associated with mailing or faxing medical records;
- Reduce delays and frustrations associated with paper submissions; and
- Lessen in-person visits to retrieve medical records.
BCBSIL is aiming to integrate payer-provider transactions and processes within providers’ daily Availity workflow with this medical attachment application as well as the Clinical Quality Validation (CQV) and Claim Encounter Reconciliation Application (CERA). Each tool has a specific purpose, so be sure to follow the guidelines for use. Also remember that records should only be submitted upon request from BCBSIL.
Mailing and faxing medical records remain options for all independently contracted providers.
If you are not a registered Availity user, we encourage you to register with availity.com and complete the online application, at no charge. Becoming a registered Availity user grants access to many other tools and resources, while also allowing you to begin using new business solution tools immediately upon launch.
For more information, review the tip sheet on the Provider Tools page. Check back for News and Updates on the BCBSIL Provider website for scheduling of online training sessions.
At this time, electronic medical record request and submission process are not available for medical record requests resulting from utilization review activities or the claims adjudication process.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by this vendor, you should contact the vendor directly