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

December 21, 2018

Blue Cross and Blue Shield of Texas (BCBSTX) is committed to making 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 BCBSTX. The necessary documentation can be submitted electronically through the Availity® Provider portal.

Submitting requested records is easy. Once users log into the Availity Provider portal, requests for these medical records from BCBSTX will display in the Notification Center. Providers may then upload and submit medical record documentation using the "Medical Attachments" application. Providers can track and audit their submissions.

To receive and respond to these medical records requests, providers must be registered with Availity. To enable this feature, administrators must log in and select Enrollment Center, then Medical Attachments Setup, then enter the required data.

BCBSTX 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. 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 providers to begin using the new payer-provider's business solutions immediately upon launch.

Check for News and Updates on the BCBSTX provider website for scheduling of online training sessions and additional information including Tip Sheets 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 BCBSTX. BCBSTX 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 such vendors, you should contact the vendor(s) directly.