Commercial Risk Adjustment (CRA) Reporting Update: Retrospective Program continues

Continuing our 2019 CRA updates, we request your assistance in helping us to accurately report our member’s health status to the Centers for Medicare & Medicaid Services (CMS).

 

2019 retrospective chart request

Retrospective medical chart collection begins in November and it is the most significant and largest volume of our requests.  We appreciate your collaboration as we work through the requests and submit to your medical records department in a timely manner.

 

Electronic options for chart collections

We have 4 electronic options for chart collections:

1. Remote/direct Anthem access
2. Electronic medical record (EMR) Interoperability with 4 EMR systems
3. Inovalon virtual visit or onsite
4. Secure FTP

 

Submitting medical charts can be time consuming for your staff. Utilizing an electronic option can help alleviate the constraints on your staff’s resources and time. 

 

The most efficient electronic option is to allow the Anthem medical coder team to have direct connection access to your EMR system (Option 1), so that we may retrieve the records ourselves. Our team has collaborated with several providers and facilities to have direct access to their EMR systems to collect the charts. 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. 

 

If you are interested in any of these electronic options, or you would like to grant Anthem medical coders direct access to your EMR system, please contact Alicia.Estrada@anthem.com, our Commercial Risk Adjustment Representative who supports your area.

 

Thank you for your continued efforts with our CRA Program, and your help in expediting chart collection requests.