Medical Records Request
Medical records requests are a key part of quality and risk adjustment activities. This effort ensures that our members have access to quality, affordable healthcare.
Your office may receive medical records requests to support:
- Commercial risk adjustment
- Medicare Advantage risk adjustment
- Marketplace (Exchange) HEDIS
- Medicare Advantage HEDIS/5-Star Rating
The success of these programs relies on provider partnership in three key areas:
- Claims coding that is complete, accurate, and timely
- Medical record documentation that validates completion of clinical care and substantiates claims
- Submission of select medical records to support coding and documentation reviews and audit and to validate completion of clinical care to supplement claims data
To make sure the right person in your office receives our medical records requests, please send us an email with the name and email address of the appropriate contact person in your office.
Requests for medical records may be initiated by one of our vendor partners requesting records on our behalf. We have a business associate agreement with our vendor partners 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) requirements regarding patient confidentiality. Patient-authorized information releases aren’t required for you to comply with these medical records requests.