Blue Cross Complete Claims Payment Medical Record Review Mailing Address Clarification
Blue Cross Complete (BCC) of Michigan is contracted with OptumInsight Inc. for payment integrity services, which include the periodic review of claims and related documentation to validate coding practices, payment accuracy, regulatory compliance and adherence to the Blue Cross Complete payment policies, utilization standards and provider contract requirements.
This includes a medical record review process for professional claims. Medical records may be requested to validate billed services through a letter from Optum, on BCC’s behalf. If medical records received don’t support the billed service, the claims will remain denied. If medical records support the claims, the claims will be automatically processed for payment without being resubmitted.
Instructions for providing medical records are included in each Optum medical record request letter. Providers are advised to carefully read the instructions page for providing required documentation that accompanies each request.
If mailing medical records through the U.S. Postal Service or other delivery method, providers must use one of the addresses given directly on the medical request letter. Letters sent to any other address, including Blue Cross Complete at the Town Center in Southfield, will be rejected.
If you have any questions or concerns, contact your Blue Cross Complete provider account executive or call Provider Inquiry at 1-866-447-3525.