Ciox Health now retrieving our medical records for Medicare Advantage risk adjustment services

Blue Cross Blue Shield of Michigan and Blue Care Network request medical records every year to comply with:

• The Centers for Medicare & Medicaid Services’ standards for data submission and coding accuracy

• CMS and the U.S. Department of Health and Human Services regulations and quality standards for patient care

Here are the vendors who perform medical record retrievals on our behalf:

1. Ciox Health:
   
   
• This vendor continues to retrieve in-state Medicare Advantage members’ medical records for risk adjustment services.
  
  
• Ciox Health is contractually bound to preserve the confidentiality of members’ protected health information obtained from medical records. This is in accordance with the Health Insurance Portability and Accountability Act of 1996.
2. Inovalon:
   
   
• This vendor continues to retrieve our in-state Healthcare Effectiveness Data and Information Set, or HEDIS^®, medical records. This vendor performs retrievals of Blue Cross PPO and Medicare Advantage PPO members’ records from March through May each year.
  
  
• This is also the vendor for our out-of-state Medicare Advantage risk adjustment chart retrieval services.
3. Verscend: This vendor continues to retrieve medical records for our in-state commercial (non-Medicare) risk adjustment business.

Reminder: You won’t need to submit patient-authorized information releases to comply with medical records requests when both the provider and health care plan have a relationship with the patient, and the information relates to this relationship [45 CFR 164.506(c)(4)]. For more information about privacy rules, go to hhs.gov/ocr/privacy.**

Behavioral health providers only need to submit documentation that confirms the diagnosis the patient is being treated for, such as encounter notes, SOAP notes or progress notes. This documentation doesn’t require a signed consent from the patient. Psychotherapy notes containing personal information between the provider and patient are not being requested.

If you have any questions, contact Blue Cross provider outreach consultants Sue Brinich at 586-839-8614, Tom Rybarczyk at 313-378-8259 or Corinne Vignali at 313-969-0417.

Ciox Health, Inovalon and Verscend are independent companies that do not provide Blue Cross products or services.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.