Upcoming Medical Retrieval Requests
Background
Each year, CareFirst BlueCross BlueShield, CareFirst BlueChoice, Inc. and their subsidiaries and affiliates (collectively “CareFirst”) are required to participate in several medical record retrieval requests to report certain information about the health status of identified members. These members may not have been evaluated and/or treated during the past year.
The purpose of these requests is to provide the Centers for Medicare and Medicaid Services (CMS) with a better understanding of the data that they receive regarding disease prevalence, coding interpretation and variances across the country.
Current Situation
We recognize the burden these mandatory requests place on your practice and are working to minimize unexpected requests by streamlining processes. To start, we are providing you with a snapshot of each retrieval period. You may receive outreach letters tied to the campaigns listed below:
|
Retrieval Period |
Lines of Business |
Retrieval Period |
Vendor |
CMS Submission Deadline |
|---|---|---|---|---|
|
BCBSA Provider Exchange |
Medicare Advantage |
October – November 2022 |
Episource |
November 30, 2022 |
|
MAPD 2021 risk adjustment chart retrieval |
Medicare Advantage |
October 2022 – January 2023 |
January 31, 2023 |
|
|
DSNP 2021 risk adjustment chart retrieval |
Medicare Advantage |
October 2022 – January 2023 |
Change Healthcare |
January 31, 2023 |
|
ACA 2022 Risk Adjustment retrospective chart retrieval |
Commercial |
January 2023 – April 2023 |
May 1, 2023 |
|
|
HEDIS Quality 2022 Measure chart retrieval |
Commercial |
January 2023 – April 2023 |
June 15, 2023 |
|
|
HEDIS Quality 2022 Measure Chart Retrieval |
Medicare Advantage |
February 2023 – April 2023 |
CareFirst HEDIS team |
June 15, 2023 |
|
2022 Risk Adjustment Data Validation |
Commercial |
July 2023 – December 2023 |
Cognisight |
January 2024 |
Please send requested records directly to the contact listed in the letter(s) you receive.
Due to CMS requirements, this information is extremely time sensitive. Please respond within 15 days of receiving the original request.
How do I prepare for the chart retrieval request?
- Make sure your information with CareFirst is up to date. Visit carefirst.com/updateproviderinfo for instructions on how to update and attest your data with CareFirst.
- Please provide an updated phone number and fax number for your practice, if applicable.
- Please share the name and contact information of the staff member who will be managing the chart retrieval process and responding to the chart retrieval requests. Please send updated chart retrieval contact information to HEDISFax@carefirst.com
- Ensure your practice’s email address is up to date with CareFirst communications.
- Provide electronic medical record (EMR) access to the vendors. This will be the fastest and least disruptive way to close out the chart requests. Instructions on how to provide this access will be provided in the chart requests. Vendors will provide additional options for submitting charts, which may include on-site access, if EMR access is not available. Refer to the details in the requests.
- Respond to chart retrieval requests in a timely manner, within one to two weeks. This will eliminate disruptive follow-up calls and requests. Please use the dates provided to support the preparation process for practice staff to respond to these requests.
Why must I comply with CareFirst’s request?
As part of CareFirst’s network, we need your support with this initiative to ensure CareFirst’s risk scores and quality performance are accurately represented to CMS. This will help ensure effective operation of CMS’s population health programs for Quality and Risk Adjustment. Your participation and response to these requests is part of your contract as a member of the CareFirst network.
What are the benefits of chart requests?
While record audits are a requirement, there are clear benefits to your engagement beyond simply remaining in compliance with your contract.
- Members’ data will be more accurate in CareFirst systems, which allows us to better coordinate their care and identify resources or programs they are entitled to as part of their plan design.
- CareFirst can better report on and adjust for the complexity of our members. For those in value-based programs, this will translate into a more accurate budget to care for your assigned population and more actionable quality reporting from us to coordinate your patient’s care.
- There will be fewer gaps in quality data and scoring tools: PCMH Quality Scorecard, CAHPS, HEDIS, Provider Profile Scores and Risk Adjustment performance will all benefit. Better quality scores can increase provider incentives for providers in certain value-based programs and can improve CareFirst health plan performance.
Who should I contact if I have questions?
Questions specific to a medical record request should be directed to the vendor. For general questions, you can reach out to Provider Relations at 410-872-3512 or 833-939-4107 (providers in PCMH or other value-based arrangements can direct questions to their Practice Consultant).
We are committed to becoming a better business partner. Other ideas on how CareFirst can reduce the burden associated with record requests can be sent to learning@carefirst.com.