October 19, 2017
Premera often contacts providers with medical records requests.
This fall and in continuing in 2018, your office may receive medical records requests, conducted by our partners Altegra and Verscend. One set of requests supports our Commercial Risk Adjustment program and the other supports Healthcare Effectiveness Data and Information Set® (HEDIS) measures.
Commercial Risk Adjustment medical records retrieval
When: Late October/Early November- April 2018
Why: Helps ensure that all our customers' medical conditions documented in their medical records are consistent with diagnoses coded on submitted claims.
How: You'll receive a letter about the record request, followed by a phone call from Premera's partner, Altegra Health. Your Altegra Health contact will review the list of medical records being requested from you and help determine which record submission method 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 2018 , continuing until May
Why: Used across the U.S. healthcare industry, HEDIS is a set of standardized performance measures that help consumers compare healthcare quality. Medical records, in addition to the diagnosis and procedure codes you submit on claims, provide evidence of the quality care you deliver.
How: Premera's partner Verscend will contact you.
We coordinate our medical record retrieval efforts across our programs so that we don't ask you for the same record twice. (We may reach out to you if we need additional dates of service or record types for particular customers.)
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.