Responding to Electronic Quality and Risk Adjustment Medical Record Requests Via Availity® Provider Portal

Posted December 5, 2018

Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to help make it easier for providers to do business with us. Coming soon providers will be able to receive electronic quality and risk adjustment medical record requests from BCBSIL and submit the necessary documentation electronically through the Availity Provider Portal.

To receive and respond to these medical records requests, you must be registered with Availity. Once registered users log into the Availity Provider Portal, requests for these medical records 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 enable this feature, administrators may log in and select:

  • Enrollment Center
  • Medical Attachments Setup
  • And then enter the required data

BCBSIL aims to integrate new transactions and processes within providers’ daily Availity workflow. 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; and
  • Lessen in­person visits to retrieve medical records.

Mailing and faxing medical records remain options for all independently contracted providers.

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 business solution tools immediately upon launch.

Check back for News and Updates on the BCBSIL Provider website for scheduling of online training sessions and a tip sheet on this tool.

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.

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 BCBSIL. BCBSIL 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 this vendor, you should contact the vendor directly.