Ciox Health is retrieving medical records for Medicare risk adjustment services

Blue Cross Blue Shield of Michigan and Blue Care Network are using Ciox Health to perform medical record retrieval for risk adjustment services for Medicare Advantage members, which started in March 2017.

Inovalon is continuing to serve 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.

Verscend is still the medical record retrieval vendor for in-state commercial risk adjustment business and continues 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 federal quality standards for data submission, coding accuracy and patient care.

Ciox Health is 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 Blue Cross provider outreach consultant Corinne Vignali at 313-225-7782.

Ciox Health, Inovalon and Verscend are independent companies that contract with Blue Cross Blue Shield of Michigan and Blue Care Network to provide medical record retrieval services.

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

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