BLUE REVIEW^SM

May 2024

Requests for Behavioral Health Documentation for Medicaid Members

Behavioral health providers may receive requests from Blue Cross and Blue Shield of Illinois for our Blue Cross Community Health Plans^SM and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM members’ medical records and supporting documentation. We review documentation for behavioral health records to comply with regulatory standards and to monitor our members’ care. This includes documentation for:

• Confidentiality and security standards
• Consent for treatment and medications
• Demographic information
• Allergies
• Medical and/or behavioral health history
• Treatment plans
• Discharge plans 

Providers are required to comply with our requests for records, as indicated in the BCBSIL Provider Manuals and according to your contract terms.

Providing Documentation
We may contact you by fax, email or phone to provide the records needed and details on how you can return them to us.
If you receive a request:

• Please provide complete and accurate records and supporting documentation in the requested timeframe.
• Ensure a credentialed provider signs and dates all documents.
• Review with staff members documentation requirements and standards.

Patient authorization isn’t required to release these records, as their collection is considered a component of health care operations under the Health Information Portability and Accountability Act. BCBSIL doesn’t reimburse providers for the cost of medical records.