Medical records request for risk adjustment
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Additional information, including frequently asked questions and answers, will be available at www.anthem.com/ca/medicareprover > Important Medicare Advantage Updates.
ABSCRNU-0011-19 April 2019 76239MUPENMUB
May 2019 Anthem Provider Newsletter - Colorado
Anthem Blue Cross and Blue Shield (Anthem) is working with Optum CiOX Health (CiOX) to request medical records for risk adjustment. Risk adjustment is the process by which CMS reimburses Medicare Advantage plans, such as Anthem, based on the health status of their members. Risk adjustment was implemented to pay Medicare Advantage plans more accurately for the predicted health cost expenditures of members by adjusting payments based on demographics (age and gender), as well as health status.