New EMR messaging alerts aim to close gaps in care for ACA patients

Starting this month, your EMR system will begin receiving bi‑directional messaging that flags gaps in care for patients covered under the Affordable Care Act (ACA) plans. These messages are designed to help you identify and address chronic conditions, as well as missing services, screenings, and documentation before claims are submitted. These gaps in care are identified by our Commercial Risk Adjustment (CRA) department for the purpose of assessing your patients’ health and closing possible gaps in care.

Why it matters

As the physician of a patient who has coverage under ACA‑compliant plans, you play a vital role in accurately documenting the health of the patient and ensuring compliance with ACA program reporting requirements. CRA relies on complete clinical data to document risk‑adjustable conditions accurately with CMS annual reporting. When key information is missing from claims, it results in increased chart requests from your health information management department.

How it works

Messages will appear in the EMR for patients with open care gaps. A physician can review the EMR alerts and ensure care gaps are addressed and properly documented. Submit claims with the highest specificity of coding and all relevant clinical data.

Please contact our CRA team if you have any questions: prospectiveteam@anthem.com
Thank you for your continued efforts to help close gaps in care.