February 7, 2019
Beginning in February 2019, Cotiviti, Inc., previously Verscend, may request member medical records on behalf of Premera Blue Cross as part of an annual medical record review. This process will be completed by May 6, 2019.
Healthcare Effectiveness Data and Information Set (HEDIS®) is a set of nationally recognized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS review occurs each year and NCQA uses the data to monitor a health plan’s performance. It’s not a provider review. Because claims cannot provide the comprehensive data needed for HEDIS®, we must collect additional information through medical record review.
Premera has a business associate agreement with Cotiviti and a confidentiality agreement with their employees on behalf of our providers and members. Any information shared during medical record review activities is confidential in accordance with all applicable state and federal laws and Health Insurance Portability and Accountability Act (HIPAA) regulations about patient confidentiality.
Providers can send Cotiviti medical records in the following ways:
- Uploading to Cotiviti’s secure website at submitrecords.com
- Sending through secure fax at 888-254-2678
- Mailing to Cotiviti at 66 E. Wadsworth Park Dr., Suite 1070, Draper, UT 84020
- Providing Cotiviti remote access to their electronic medical records (EMR). Providers can call Cotiviti at 801-506-1998 for remote EMR setup.
- Calling Cotiviti at 801-506-1907 to set up onsite retrieval. If a provider requires onsite retrieval, Verscend will dispatch medical record technicians to scan requested records that the provider has pulled prior to their arrival.
The reviews are based on our membership, not provider contract status or location. This could affect providers nationwide. This includes Premera contracted and non-contracted providers throughout Washington and Alaska and in our BlueCard® network throughout the U.S. It also includes providers contracted in contiguous counties, such as providers contracted with Premera in Idaho.