Anthem Commercial Risk Adjustment (CRA) program update: retrospective program begins; prospective program continues

Anthem is committed to collaborating with the provider community and offering flexible options to meet the needs of both the retrospective program and the prospective program. The retrospective program focuses on medical chart collection. The prospective program focuses on member health assessments for patients with undocumented Hierarchical Condition Categories (HCC’s), in order to help close patients’ gaps in care.

 

Retrospective Chart Requests

We appreciate that care providers across the country on the front line are committed to providing care during these challenging times, and as such, that care results in a visit where we may need the medical chart.  Medical chart collection must be done to obtain undocumented HCC’s on your patients in order to be compliant with the provisions of the Affordable Care Act, (ACA), that require our company to collect and report diagnosis code data for ACA membership.  This process will begin in June. In order to make these chart requests the most efficient for your office, we have electronic options available:

• EMR Interoperability
• Allscripts (Opt in - signature required)
• NextGen
• Athenahealth
• MEDENT
• Remote/Direct Anthem access
• Vendor virtual or onsite visit (if the offices are opened back up from COVID-19 closures)
• Secure FTP

The goal of these electronic options is to both improve the medical record data extraction and the experience for Anthem’s providers. If you are interested in this type of set up or any other remote access options, please contact the Commercial Risk Adjustment Network Education Representative listed below.

 

Prospective Patient Outreach (Incentive opportunity for properly completed health assessments:  Physicians are eligible to receive $100 for electronic submissions or $50 for paper in addition to the office visit reimbursement.)

 

We encourage members to form a relationship with their Primary Care Physician to complete a clinical assessment to ensure you have a clearer picture of your patients’ health. Telehealth visits are an acceptable format for seeing your patients and assessing if they have risk adjustable conditions. Previous Anthem news updates have given telehealth reimbursement guidance to follow when submitting the claim.

 

As a reminder, the May newsletter mentioned incentives for prospective program participation ($100 or $50). We would be happy to meet and review incentive opportunities along with other flexible options for program participation and chart collection. Please contact our Commercial Risk Adjustment Network Education Representative, Alicia Estrada at Alicia.Estrada@anthem.com to set up a meeting.

 

Thank you for your continued efforts with the CRA Program.

 

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