New program to streamline medical record request process starts Jan. 1, 2020

In the November 2019 issue of The Record, we told you about a new Blue Cross and Blue Shield Association initiative that will help streamline the medical record retrieval process for Blue Cross Medicare Advantage PPO patients nationwide.

The National Coordination of Care Program initiative launches on Jan. 1, 2020, and allows Blue Cross Blue Shield of Michigan to retrieve medical records for out-of-area Medicare Advantage PPO members, in addition to Blue Cross patients who live in Michigan. “Out of area” refers to patients who live in Michigan but are enrolled in another state’s Blue plan. This includes medical record requests for the purposes of closing gaps in care for HEDIS^®, star ratings and risk adjustment purposes.

This new patient population will be included in medical record requests from both Blue Cross and its vendors, and records will be received in the formats currently in use. Blue Cross will pay the same for out-of-area records as we pay for Michigan Medicare Advantage PPO patients, and under the same circumstances.

Blue Cross and its vendors are contractually bound to preserve the confidentiality of health plan members’ protected health information obtained from medical records in accordance with Health Insurance Portability and Accountability Act regulations. Patient authorization releases aren’t required for you to release medical records to Blue Cross or its vendors.

Behavioral health providers may release encounter notes billed with evaluation and management codes without a signed consent from their patients. Health care providers aren’t required to provide psychotherapy notes, which require a patient’s authorization prior to disclosure.

We look forward to working with you and your practice to include this patient population in our current processes. Questions about out-of-area medical record retrievals can be directed to Laurie Latvis, director of Quality and Provider Education, at llatvis@bcbsm.com or 313-225-7778.

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