Commercial Risk Adjustment, retrospective program begins

Continuing our 2019 CRA updates, Anthem Blue Cross (Anthem) requests your assistance with respect to our Commercial Risk Adjustment (CRA) reporting processes.

As a reminder, there are two approaches that we take (Retrospective and Prospective) to improve risk adjustment reporting accuracy.  This month we’d like to focus on the Retrospective approach, and the request to our providers.

Retrospective Program:

• Focus is on medical chart collection
• Medical chart collection will start soon (separated in three different time periods)
  • Period 1 (June 2019)
  • Period 2 (November 2019)
  • Period 3 (January 2020)
• Anthem’s medical chart collection is in compliance with the ACA provision to collect and report diagnosis code data for ACA members

 

Electronic options for chart collections:

 

• Remote/Direct Anthem Access
  • The most efficient option is to allow Anthem’s medical coder team to have direct connection access to your EMR system for Anthem to retrieve member records.
• EMR Interoperability. Options are in place for the following EMR systems
  • Allscripts (Opt in –signature required. Need to work directly with the CRA representative for your region)
  • NextGen (Opt out – auto-enrolled)
  • Athenahealth (Opt out – auto enrolled)
  • MEDENT (Opt in – signature required. Need to work directly with the CRA representative for your region)
• Inovalon virtual visit or onsite
  • Inovalon will work directly with your office to utilize electronic connectivity for a virtual visit, or they will have their staff go into the office for medical record retrieval based on a scheduled time that is convenient.
• Secure FTP

• Set up directly with our vendors as a temporary secure FTP to transfer medical records. 

 

If you are interested in any of these electronic options, or would like to grant our Anthem medical coders with direct access to your EMR, please contact our CRA Representative:

California, Colorado and Nevada -  Socorro.Carrasco@anthem.com