Mar 1, 2021

Medical Records Cover Sheet Reminder

As a reminder when sending in Medical Records to BCBSRI, a valid coversheet should be placed on top of the Medical Records and all necessary information should be filled out.

The following forms are considered a cover sheet:

•Claim Adjustment formAppeal form

•Medical Records form

•DME Unlisted Code form

•Unlisted Procedure Claim form Professional

•Unlisted Procedure Claim form Facility

•Response letter to request for Medical Record

Effective 05/01/2021 the Medical Records team will be returning any Medical Records without any of the above referenced forms as a cover sheet.

All of these cover sheets can be found on bcbsri.com > Providers > Forms