Has your patient received a request for an accident questionnaire? Accident questionnaires are automatically generated to the member if there are trauma related diagnosis codes on the claim.
Often, the questionnaire is overlooked by the member or it is returned incomplete and without sufficient information to determine if the service was related to an event for a third-party may be responsible.
Under both scenarios, multiple attempts are made to reach the member, as it is ultimately their responsibility to return the completed questionnaire with all required information. For this reason, we ask that you allow the member at least 60 days to respond and for us to complete our review of the submitted information.
How can you help?
If your claim has been denied pending an accident questionnaire response, as a health care provider, you can:
- Contact your patient to encourage them to complete and return the questionnaire. Members care respond to the questionnaire via mail, calling the customer services number on the back of their ID card, or online using the website located on their ID card.
- Have members complete the accident questionnaire at the time of service. However, only submit the questionnaire on behalf of the member if your claim is pending for this reason. Not all claims require the questionnaire and we want to avoid receiving unwarranted questionnaires. Also, be sure the accident questionnaire is completed and signed by the member.
If 60 days have passed from the processed date of the claim, you may:
- Submit the questionnaire completed by the member at the time of service; or
- Submit medical records in lieu of the questionnaire.
If submitting medical records, please note the following:
- Medical records should be submitted using the appropriate avenues for document submission (e.g., My Insurance Manager℠, fax, etc.) and should provide all information related to the service.
- Submission of medical records does not guarantee claims will be related for processing. Medical records may be inconclusive for information we might need (such as auto insurance details). Therefore, the best practice is to have the patient complete the accident questionnaire at the time of service when feasible.
- Please include any phone numbers or email addresses you may have for your patient. This will assist us in reaching out to the member if any additional information is still needed.
- Medical records will not be accepted after the timely response date. We encourage you to submit medical records within six months of the process date of the claim.
If you have any questions related to this bulletin, contact Provider Education using the Provider Education Contact Form located on www.BlueChoiceSC.com.