February 05, 2020
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
Beginning February 10, 2020, Anthem Blue Cross will begin using Availity’s medical attachment functionality to request and obtain medical records from providers during its post payment claims review (audit) process. To utilize this functionality, providers must opt in to the medical attachment functionality through the permissions in Availity’s enrollment center. Providers who have not opted in will continue to receive requests via paper.
The new functionality is for post payment claim review medical record requests from the Payment Integrity Quality Claims Review (provider audit) department only. At this time, the Program Integrity Special Investigations Unit post payment review is not included, but according to Anthem it will be included at a future date. Vendor requests for medical records on behalf of the payor are not impacted.
Requests will be received in the provider’s Medical Attachment “inbox” in Availity. Anthem reports there will be no duplicate requests, meaning if it requests the records electronically, it will not also send a paper request. When uploading records in Availity, the attachments are received in almost real time and are delivered electronically to the payor’s systems through secure means. Nothing is stored in Availity.
For more information regarding this program, see the Anthem Blue Cross Frequently Asked Questions and training video Availity Training on Electronic Medical Records for Program Integrity.