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.

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.

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.

• 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.

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.

• 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.