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Updates to Risk Adjustment Medical Record Collections

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to thank you for sending in the requested medical records required for our risk adjustment program. Your assistance helps us support the health status of our members to the Centers for Medicare and Medicaid Services (CMS), resulting in stabilized member premiums.

Here are a few risk adjustment updates, as well as an updated timeline for the remainder of 2017:

Medical Collection Vendors
This year, we have a new medical record collection vendor. Providers will be contacted by Inovalon and/or CIOX. We appreciate your cooperation with these vendors. Please contact George Taylor at Blue Cross NC (919-765-2750) with any questions about these vendors or their requests for records.

Health and Human Services Risk Adjustment Validation Audit
A few records have been added to the Health and Human Services (HHS) Risk Adjustment Validation (RADV) audit of our 2016 data. The total number of records added for the state of North Carolina is 30, so the request to providers will be minimal. Outreach for these records has already begun, and we ask that these records be delivered no later than November 10.

Delayed Chart Pull Lists
Some chart pull lists coming from our new Medicare vendor have been delayed. Therefore, the timeline for those listings has been extended. Blue Cross NC and the vendor will work with those facilities to develop a new schedule.

 

Updated Timeline for the Remainder of 2017

Line of Business

Collection Type

Collection Period

Collecting Entity

Dates of Service

Commercial (ACA)

HHS RADV Audit

June 1 – November 10, 2017

Blue Cross NC

2016 Calendar Year

Commercial (ACA)

Blue Cross NC 2017 Data Project

June 1, 2017 – February 28, 2018

Ciox

2017 Calendar Year (or through time of collection, if earlier than December)

Medicare Advantage

Blue Cross NC 2017 Final Data Project

June 1 – November 30, 2017

Inovalon

2016 Calendar Year

Medicare Advantage

Blue Cross NC 2017 Final Data Project

June 1 – November 30, 2017
(Exceptions noted above)

Ciox

2016 Calendar Year