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Medical Record Requests

Blue Cross and Blue Shield of Alabama routinely requires submission of clinical information for the following: unlisted codes; claims to which a modifier 22 is appended; claims requiring review for medical necessity including services or procedures for which Blue Cross has issued a coverage statement, coverage guidelines or for which Blue Cross has a stated medical policy; potentially cosmetic claims; claims that are investigational in nature; and claims involving potential pre-existing conditions. Clinical information may also be required for claims that include services listed as contract exclusions under members’ contracts, services which require pre-certification and services under review for potential fraud or abuse.