A member's Blue Plan may require medical records to review the claim. Blue Plans can send and receive medical records electronically.
Please do not proactively send medical records with the claim, unless requested. Unsolicited claim attachments may cause claim payment delays.
Requests may be issued as part of the pre-authorization process or as part of claim review and adjudication.
If you receive requests for medical records from other Blue Plans prior to rendering services, as part of the pre-authorization process, you will be instructed to submit the records directly to the member's Plan that requested them. This is the only circumstance where you would not submit the records to Regence.
Claim review and adjudication
These requests will come via letter from Regence, requesting specific medical records and including instructions for submission. Please note:
- An initial communication, generally in the form of a letter, should be received by your office requesting the needed information.
A remittance may be received by your office indicating the claim is being denied pending receipt and review of records.
- Occasionally, the medical records you submit might cross in the mail with the remittance advice for the claim indicating a need for medical records. A remittance advice is not a duplicate request for medical records. If you submitted medical records previously, but received a remittance advice indicating records were still needed, please contact Regence to ensure your original submission has been received and processed. This will prevent duplicate records being sent unnecessarily.
- If you received only a remittance advice indicating records are needed, but you did not receive a medical records request letter, contact Regence to determine if the records are needed from your office.
- Upon receipt of the information, the claim will be reviewed to determine the benefits.
Processing of medical records requests
- Ensure timely processing by only sending the information specifically requested.
- Submit the information to Regence as soon as possible to avoid further delay using one of these options:
Fax: 1 (888) 208-8039
- Separate documents for different patients using a blank page, preferably a different color.
- Follow the submission instructions given on the request, using the specified address or fax number. Note: The address or fax number for medical records may be different than the address you used to submit the claim(s).
- Include the cover letter you received with the medical records request when submitting the medical records. This is necessary to make sure the records are routed properly once received by Regence.
- Email: Regence_BlueCard_Records@Regence.com
Attn: Regence BlueShield of Idaho
P.O. Box 1106 MS LD3S
Lewiston, ID 83501