October 4, 2018
Starting this fall, your office may receive medical record requests from our partners, Change Healthcare and Cotiviti (formerly Verscend). These requests will support our Commercial Risk Adjustment program and Healthcare Effectiveness Data and Information Set® (HEDIS) measures.
Commercial Risk Adjustment medical records retrieval
When: October 2018 - April 2019
Why: To ensure customers' medical conditions documented in their medical records are consistent with diagnoses coded on submitted claims.
How: Your office will receive a letter about the request from Change Healthcare followed by a phone call. The Change Healthcare representative will review the list of medical records being requested and help determine the record submission method that works best for you.
Our goal is to have all records received within 30 days of your receipt of the record request.
Healthcare Effectiveness Data and Information Set® (HEDIS) measures
When: Early 2019 until May 2019
Why: HEDIS is a set of standardized performance measures that help consumers compare healthcare quality. Medical records, in addition to the diagnosis and procedure codes, provide evidence of the quality care you deliver.
How: A representative from Cotiviti will contact you.
Our medical record retrieval efforts will be coordinated across our programs so that we don't ask you for the same record twice, but may reach out if we need additional information.
We’ll be requesting records throughout the year to support our Risk Adjustment, Quality, and Medicare Advantage Programs for internal reviews and external audits. We’ll continue to let you know about details and the vendors requesting records on our behalf as projects are planned.
These annual efforts are just one of several ways we collaborate with providers to ensure customers have access to quality, affordable healthcare. We appreciate your past participation and continued support.