Requests for Medical Records

October 6, 2020

Medical record documentation may be requested by BCBSTX to determine the medical necessity for services in conjunction with BCBSTX policies. Additionally, medical records may be requested to meet quality standards in applicable health care regulations.

BCBSTX participating providers are required by their agreements to establish and maintain an accurate medical record for members. At a minimum, the medical record should:

  • Include information about the member and a description of all services rendered as dictated by generally accepted practices and standards,
  • Be maintained for the period of time required by applicable law
  • Be established and maintained in all instances as required by the BCBSTX Policies and Procedures, as defined in your participation agreement.
  • Be legible, complete, dated, timed, and authenticated.

As set forth in your participation agreement with BCBSTX, Providers are required to respond to requests for medical records from BCBSTX timely and at no cost. This requirement extends to records requested by not only BCBSTX but also its designees/third party vendors. All records must be submitted to BCBSTX within the requested timeframe at no cost. If you receive a request for medical records, we encourage you to reply within 3 to 5 business days to ensure there are no delays in claims processing.

BCBSTX values its relationship with all participating providers and appreciates their prompt response to all requests for medical records. If you have any questions, please contact you Network Management Representative.