October 21, 2021
This fall, your office mayreceive medical record requests from Change Healthcare and Cotiviti. Providerswho use CIOX Health for medical record management may be contacted directly byCIOX, as they are also working with Premera for medical record retrieval. Theserequests support our commercial risk adjustment program and HealthcareEffectiveness Data and Information Set® (HEDIS) measures.
CommercialRisk Adjustment Medical Records Retrieval
When: October 2021 through April 2022
Why: Ensures ourcustomers' medical conditions documented in their medical records areconsistent with diagnoses coded on submitted claims.
How: You'll receive a letter about the record request,followed by a phone call from Change Healthcare. Change Healthcare will reviewthe list of medical records being requested from you and help determine whichrecord submission method works best for you.
The goal is to have allrecords received within 30 days of your receipt of the record request.
HealthcareEffectiveness Data and Information Set® (HEDIS) measures
When: Januarythrough May 2022
Why: Used across the U.S. healthcare industry, HEDIS isa set of standardized performance measures that help consumers comparehealthcare quality. Medical records, in addition to the diagnosis and procedurecodes you submit on claims, and supplemental data submitted provides evidenceof the quality care you deliver.
How: Cotiviti will contact you.
Premera coordinates ourmedical record retrieval efforts across our programs so that we don't ask youfor the same record twice. We may reach out to you directly if we needadditional dates of service, demographics, or record types for specificcustomers.
These annual efforts arejust one of several ways we collaborate with providers to ensure customers haveaccess to quality, affordable healthcare. We appreciate your past participationand continued support.