State & FederalMedicare AdvantageMay 31, 2020

Empire working with Optum to collect medical records for risk adjustment

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Risk adjustment is the process by which the Centers for Medicare & Medicaid Services (CMS) reimburses Medicare Advantage plans, 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.

 

In 2020, Empire will work with Optum,* who is working with Ciox Health,* to request medical records with dates of service for the target year 2019 through present day.

 

Jaime Marcotte, Medicare Retrospective Risk Program Lead, is managing this project. If you have any questions regarding this program, please contact Jaime at jaime.marcotte@anthem.com or
1-843-666-1970.

 

Additional information, including an FAQ, will be available on the provider website under Important Medicare Advantage Updates.

 

* Optum and Ciox Health are independent companies providing medical record review services on behalf of Empire BlueCross BlueShield.

 

EBSCRNU-0105-20/EBCCRNU-0106-20 April 2020

509218MUPENMUB

 

PUBLICATIONS: June 2020 Empire Provider News