March 1, 2017
One use of medical records is to provide evidence of the quality of care you deliver. Plans, including Premera, regularly review medical records to supports the success of risk adjustment, Healthcare Effectiveness Data and Information Set (HEDIS), and the Medicare Advantage HEDIS/5-Star rating programs.
As part of the medical records review process, you might receive a request from a Blue Cross Blue Shield Association (BCBSA) plan outside of our area. Your office may receive these medical records requests starting October 2016 and continuing through December 2017. All BCBSA plans use the same vendor, Verscend.
We appreciate your partnership in three key areas:
- Complete, accurate, and timely claims coding
- Medical records documentation that validates completion of clinical care and confirms claims
- Submission of select medical records to support coding and documentation reviews and audits, and to validate completion of clinical care to supplement claims data
If you have questions about these requests, contact our Physician and Provider Relations team at 877-342-5258, option 4.