Reminder: We’ve changed vendors for Medicare risk adjustment medical record retrievals

Blue Cross Blue Shield of Michigan and Blue Care Network, working with Data Driven Delivery Systems, will use CIOX Health/Enterprise Consulting Solutions, or ECS, to perform medical record retrieval for risk adjustment services for Michigan Medicare Advantage members. This service was previously performed by Inovalon.

DDDS will review and code medical records at sites that don’t permit scanning or copying of records. The retrieval process started in April 2016.

Inovalon will continue serving as the vendor of Blue Cross for in-state Healthcare Effectiveness Data and Information Set, or HEDIS,** medical record retrievals for Blue Cross PPO and Medicare Advantage PPO members from March through May each year.

Verisk Health will remain the medical record retrieval vendor for in-state commercial risk adjustment business and continue to partner with other Blue plans for out-of-state risk adjustment and HEDIS chart retrieval services.

Blue Cross and BCN request medical records every year to meet the Centers for Medicare & Medicaid Services’ standards for data submission and coding accuracy, and CMS’ and Health and Human Services’ regulations and quality standards for patient care.

DDDS and CIOX Health/ECS are contractually bound to preserve the confidentiality of members’ protected health information obtained from medical records, in accordance with the Health Insurance Portability and Accountability Act of 1996.

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.***

If you have any questions, contact one of the following Blue Cross provider outreach consultants:

• Sue Brinich at 313-225-8981
• Tom Rybarczyk at 313-225-0445
• Corinne Vignali at 313-225-7782

DDDS, CIOX Health/ECS, Inovalon and Verisk Health are independent companies that do not provide Blue Cross Blue Shield of Michigan products or services.

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

***Blue Cross Blue Shield of Michigan does not own or control the content of this website.