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

December 3, 2018

Blue Cross and Blue Shield of New Mexico (BCBSNM) 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 BCBSNM. The necessary documentation can be submitted electronically through the AvailityTM Provider portal.

Submitting requested records is simple. Once users have logged into the Availity Web portal, requests for these medical records from BCBSNM 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 and select Enrollment Center › Medical Attachments Setup, then enter the required data.

BCBSNM 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 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 PDF Document in the Provider Tools/Education and Reference Center at BCBSNM will be providing additional information regarding electronic medical records submissions in 2019.

At this time, medical records for utilization review and claims adjudication cannot be electronically requested or submitted through Availity. We are working on enhancing capabilities throughout 2019.

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 BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any