Thursday, April 28, 2011

Additional document required to process the claim.

Claim Documentation Requests

When additional documentation is required to process a claim, BCBSF will fax or mail a written request to
you. The request will include a letter and a routing sheet for a specific claim. The letter contains the key
data from the claim (i.e., patient name, member number, patient account number and claim number),
information requested, and the reason additional information is needed. This routing sheet serves as the
fax cover sheet or cover page for documents that are mailed back to BCBSF and is used for tracking
purposes.

The following are tips for submitting claim documentation when it is requested:

• The Routing Sheet must be only used for the matching documentation. Do not copy the Routing
Sheet for multiple claims; it is for a specific claim and member.

• The Routing Sheet must always be the top sheet attached to the documentation regardless of the
mode of return (i.e., fax, mail).

• When the documentation is returned by fax, the Routing Sheet must be fed from the top of the page
to the bottom of the page.

• Do not attach separate sets together. Fax one information package at a time. Our electronic receiving
system only recognizes the first page as the Routing Sheet and catalogues all subsequent pages
accordingly.

• Do not write on the Routing Sheet except to place an “X” within the applicable boxes to designate
what type of documentation is attached to the Routing Sheet.

• For records that contain greater than 100 pages, mail the documentation to P.O. Box 1798,
Jacksonville, Florida 32231-0014. Package it with the Routing Sheet as the first page.

• Do not send double-sided copies.

• Do not return the original letter that was sent with the Routing Sheet.

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