February 6, 2020
On January 1, 2020, a Blue Cross and Blue Shield (BCBS) National Coordination of Care program to support BCBS Medicare Advantage (MA) members launched
nationally. The program aims to increase the quality of members’ care by enabling these members to receive appropriate care, wherever they access care.
To better support all BCBS MA PPO members residing in Washington state, Premera Blue Cross is working with providers to improve care for these
members through:
- Supporting providers with additional information about open gaps in care
- Requesting medical records to get complete understanding of member health status
MA PPO members in this program can be identified by a member address in Washington state and this logo on their Blue Cross and/or Blue Shield ID Cards:
What does this new program mean to me?
This program will result in changes that will be beneficial to you, your practice, and your patients.
Gap closure requests
- In February 2020, you’ll receive HEDIS care gaps and risk adjustment coding gaps identified for members in one or more of the
following ways:
- Displayed on your monthly gap list from our online One View Population Health tool or via File Transfer Protocol (FTP)
- Displayed on a Clinical Documentation Improvement (CDI) alert received by mail or from a Provider Engagement Coordinator (PEC)
- The MA members you see may come into your practice more frequently due to Premera requesting care gap closures for greater
continuity.
You don’t need to be in contact with any BCBS plans that you’re not contracted with for the purposes of gap closure.
Reminder: As outlined in your Premera contract, you’re required to respond to requests in support of risk adjustment, HEDIS, and other government required activities
within the requested timeframe. This includes requests from Ciox, our medical record retrieval vendor, related to this program. Note that gap closures aren’t
subject to incentive programs and medical record submissions aren’t eligible for reimbursement for retrieval fees
Medical Records Requests
Providers will receive medical records requests from Premera related to patients who are MA PPO members residing in Washington state and enrolled with a BCBS plan. Per
the program structure, these members’ plans request medical records through Ciox. You don’t need to be in contact with any Blue plan that you’re not
contracted with for the purposes of medical records retrieval.
HIPAA, privacy
Consistent with HIPAA and any other applicable laws and regulations, Premera and its vendors are contractually bound to preserve the confidentiality of health plan
members’ protected health information (PHI) obtained from medical records and provider engagement on Stars and/or risk adjustment gaps. You’ll only receive
requests from Premera or its vendors that are permissible under applicable law. Also, consistent with your current practices, patient-authorized information
releases aren’t required for you to fulfill medical records requests and support closure of Stars and/or risk adjustment gaps received pursuant to this
care coordination program.
If you have any questions about the applicability of HIPAA or any other privacy law or regulation to this program, email us at ProviderClinicalConsulting@Premera.com.