Continuing our 2019 CRA updates, Anthem Blue Cross and Blue Shield (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.  We are focusing on performing appropriate interventions and chart reviews for patients with undocumented Hierarchical Condition Categories (HCC), to close the documentation and coding gaps that we are seeing with our members enrolled in our Affordable Care Act (ACA) compliant plans.


This month we’d like to focus on the Retrospective approach, and the request to our Providers:


As a reminder from our March newsletter, the Retrospective Program focuses on medical chart collection.  We continue to request members’ medical records to obtain undocumented HCC’s.  This particular effort is part of Anthem’s compliance with provisions of the ACA that require our company to collect and report diagnosis code data for our ACA membership.  The members’ medical record documentation helps support this data requirement.


2019 chart collection is about to begin


Retrospective chart collection begins in June and is known as Round 1.  Round 2 follows in November, which is our primary chase and largest volume of requests.  Round 3 is our last chart collection period and begins in January, 2020.


Electronic options for chart collections


Submitting medical charts to payers is extremely burdensome and time consuming for your staff.  Utilizing an electronic option can alleviate the constraints on both staff resources and time.

1.) Remote/Direct Anthem Access

The most efficient electronic option is to allow the Anthem medical coder team to have direct connection access to your EMR system, so that we may retrieve the records ourselves.  Our team has collaborated with several Providers and Facilities to have direct access to their EMR system so we collect the charts within our own team.  This allows for no vendor interventions and fewer handoffs of the records.  To address compliance concerns, please note that as a health plan, Anthem is a covered entity under the HIPAA Privacy Rule and is bound to protect PHI. 

Benefits of providing EMR direct connection access


  • Your Medical Records staff resources would be minimally contacted for the charts we are requesting
    • o Depending on your EMR system, requests may also be handled electronically through “push” notifications
  • Your Medical Records staff will release only those records we request into the EMR queue for which we have access
  • Cost savings from less administrative impact on staff, as well as, no paper copying costs incurred
  • Better privacy/security measures for not having to save the medical record to a desktop and then copy/save before transmittal

) EMR Interoperability -- we have electronic options already in place for the following EMR systems:

  • Allscripts (Opt in - signature required -- please work directly with the CRA Representative for your region)
  • NextGen (Opt out - auto-enrolled)
  • Athenahealth (Opt out - auto-enrolled)
  • MEDENT (Opt in - signature required -- please work directly with the CRA Representative for your region)

3.) 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.

4.) 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:


Thank you for your continued efforts with our CRA Program, and expediting these medical chart collection requests that will begin soon.

Featured In:
June 2019 Anthem Provider Newsletter - Colorado