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October 2014

Timely responses are important as medical record reviews continue through 2014

Verisk Health will continue through 2014 to gather medical records for individual and small group members on behalf of Blue Cross® and Blue Shield® Association plans nationwide. The purpose of gathering these records is to support risk adjustment and government requirements related to the Affordable Care Act.

Blue plans are using Verisk to retrieve medical records for members or from providers in other plans’ service areas.

Health plans are also required by the Department of Health and Human Services to accurately report members’ health conditions. HHS will be auditing the plans’ reported conditions.

Please respond to these requests within the requested time frame. This includes requests from Verisk on our behalf.

It’s also important to know that:

  • The reviews are in addition to the risk adjustment and HEDIS® medical record review process performed by Inovalon™ on behalf of Blue Cross Blue Shield of Michigan.
  • Effective medical record retrieval services help drive optimal quality reporting outcomes and ensure appropriate risk scores. Those factors contribute to enhanced health care delivery and affordability.

  • Verisk is contractually bound to preserve the confidentiality of health plan members’ protected health information obtained from medical records. This is in accordance with Health Insurance Portability and Accountability Act regulations.
  • Patient-authorized information releases aren’t required to comply with these requests for medical records when both the provider and health plan had a relationship with the patient and the information relates to the relationship (45 CFR 164.506(c)(4)).

For more information regarding privacy rule language, please visit hhs.gov/ocr/privacy.**

If you have any questions, contact Verisk Health at 1-877-489-8437.

**BCBSM does not control this website or endorse its general content.

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

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.