April 1, 2021
In 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:
Gap closure requests
You’ll receive HEDIS care gaps and risk adjustment coding gaps identified for members as displayed on a Clinical Documentation Improvement (CDI) alert received by fax, mail or from a provider engagement coordinator. Premera can be used as the single point
of contact for members with out of state Blue Cross or Blue Shield plans.
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 record requests from Premera related to patients who are MA PPO members residing in Washington state and enrolled with a BCBS plan. We’ll retrieve medical records using our access to your electronic medical record (EMR)
or through our vendor partner, Ciox. Premera can be used as the single point of contact for members with out of state Blue Cross or Blue Shield plans.