Responding to Electronic Quality and Risk Adjustment Medical Record Requests via AvailityTM Provider Portal

May. 15, 2018

Blue Cross and Blue Shield of Montana (BCBSMT) is committed to making it easier for providers to do business with us. Providers may now receive electronic quality and risk adjustment medical record requests from BCBSMT. The necessary documentation can be submitted electronically through the AvailityTM Provider portal. 

Submitting requested records is easy. Once users have logged into the Availity Web portal, requests for these medical records from BCBSMT 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 receive and respond to these medical records requests, you must be registered with Availity . To enable this feature, administrators must log in select Enrollment Center › Medical Attachments Setup, then enter the required data.

BCBSMT is aiming to integrate payer-provider transactions and processes within providers’ daily Availity workflow. We anticipate 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
  • Lessen in-person visits to retrieve medical records

Mailing and faxing medical records remain options for all participating providers. Network providers who are not Availity users are encouraged 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 payer-provider’s business solutions immediately upon launch.

For more information, refer to the Responding to Electronic Quality and Risk Adjustment Medical Records Requests Tip Sheet in the Provider Tools/Education and Reference Center at bcbsmt.com/provider. BCBSMT will be providing additional information regarding electronic medical records submissions will be introduced in 2018.

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.  We anticipate offering additional capabilities throughout 2018.

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 BCBSMT. BCBSMT 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 such vendors, you should contact the vendor(s) directly.