November 5, 2020
Your office may begin to receive medical record requests from LifeWise or one of our partners, Change Healthcare, Ciox, or Cotiviti. These requests support our Commercial Risk Adjustment program and Healthcare Effectiveness Data and Information Set® (HEDIS) program.
Commercial risk adjustment medical record retrieval
When: October 2020 - April 2021
Why: Commercial risk adjustment is mandated by Centers for Medicare & Medicaid Services (CMS). Review of medical records ensures that members’ 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 or Ciox followed by a phone call. The representative will review the list of medical records being requested and help determine the record submission method that works best for you.
HEDIS medical record retrieval
When: February 2021 through May 2021
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 or Ciox will contact you. Our medical record retrieval efforts will be coordinated across our programs to not ask you for the same record twice; however, we 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 inform you about details and the vendors requesting records.
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.