Skip Navigation

Back to Index

2017 Medicare Advantage Prospective Risk Adjustment News

The 2017 Medicare Advantage Prospective Risk Adjustment program is coming to a close. Once again, we want to thank all who participated in this important voluntary program. There is still time to complete and submit additional SOAP Notes for 2017. Here are a few things to remember:

  • 2017 patient encounters must be completed by December 31, 2017.
  • 2017 paper and ePASS® SOAP Note submissions must be faxed or submitted through the ePASS website by January 31, 2018.
    • We are changing vendors for the 2018 campaign, so it’s difficult to be flexible this year. Please plan to have all submissions completed by January 31, 2018.

We encourage you to use the patient scheduling list provided by Inovalon to guide you to the targeted patient encounters we are requesting. If you are submitting via ePASS, you may complete a SOAP Note for all of your Medicare Advantage members. The “Patients” tab in ePASS is the easiest way to view your entire patient list.

Here are some additional things to remember as you complete your 2017 SOAP Notes:

  • Be sure to submit a claim for the member encounter, and make sure the “Exam Date” on the SOAP Note matches the date of the encounter on the claim.
  • If you wish to use a prior encounter, please do not go back more than 60 days.
  • If you use ePASS to fill out a SOAP Note in January for a 2017 encounter, watch your encounter date. Entering 2018 will create some errors which could delay incentives.
  • Please do not print an ePASS-generated SOAP Note, and then fill it out and fax it to Inovalon. They will reject it. If you start in ePASS, please complete the submission using ePASS.

The 2017 Provider Incentives for SOAP Note completions are still being processed, and will take several months into 2018 to complete. Provider incentives have currently been paid through June 2017. We are working quickly to catch up, but please allow up to 120 days from the date of submission to receive the incentive.

2018 Medicare Advantage Prospective Risk Adjustment

The 2018 Medicare Advantage Prospective Risk Adjustment program will see some significant changes. Beginning January 1, 2018, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is changing vendors for the Medicare Advantage Risk Adjustment program. We will replace Inovalon with Pulse8 in order to align with our commercial/Affordable Care Act (ACA) risk adjustment efforts.

For the first several weeks of 2018, we’ll be closing out the prior campaign year and working with two vendors. Please take a little extra time to confirm you are working from the correct form as you complete encounters.

Here are some things to expect as the changes go into effect:

Encounter Facilitation / Encounter Support (SOAP Notes) to Provider Alerts

  • Inovalon SOAP Notes will continue through the end of 2017, and will then be replaced with provider alerts for the 2018 campaign year.
  • Provider alerts will be available in Blue e in the same format you’re familiar with for our commercial/ACA members.
  • If you would like additional information, or wish to set up training for your facility, please email Joe Richard, Blue Cross NC Risk Adjustment Program Manager.

In-Home Assessments

  • In January 2018 Blue Cross NC will begin using Pulse 8’s vendor, Advance Health, for completing in-home assessments in all counties. The core process will still be the same. Assessment results will be faxed to providers as they have in the past.
  • The form you receive summarizing the results of the assessment will look different, but the information presented will be similar.
  • A summary of the assessment will automatically be provided. Full assessment details can be provided upon request.

If you have any questions about the upcoming changes or questions about this program, please email Joe Richard, Blue Cross NC Risk Adjustment, or call Joe at 919-765-1497.

If you have questions about incentive payments, please email Willia Barber, Blue Cross NC Financial Analyst, or call Willia at 336-201-4261.