October 21, 2021
This fall, your office may receive medical record requests from Change Healthcare and Cotiviti. Providers who use CIOX Health for medical record management may be contacted directly by CIOX, as they are also working with Premera for medical record retrieval.
These requests support our commercial risk adjustment program and Healthcare Effectiveness Data and Information Set® (HEDIS) measures.
Commercial
Risk Adjustment Medical Records Retrieval
When: October 2021 through April 2022
Why: Ensures 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 Change Healthcare. Change Healthcare will review the list of medical records being requested from you and help determine which record submission method works best for
you.
The 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: January through May 2022
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, and supplemental
data submitted provides evidence of the quality care you deliver.
How: Cotiviti will contact you.
Premera coordinates 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 directly if we need additional dates of service, demographics, or record types for specific 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.