Anthem Commercial Risk Adjustment (CRA) Program Update: Retrospective Program Begins; Prospective Program Continues

Anthem Blue Cross and Blue Shield (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

 

In addition to the office visit reimbursement, physicians are eligible to receive incentive opportunity for properly completed health assessments:

• $100 for electronic submissions
                  OR
  

• $50 for paper submissions

 

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 the Commercial Risk Adjustment Network Education Representative at Mary.Swanson@anthem.com to set up a meeting.

 

Thank you for your continued efforts with the CRA Program.

 

454-0620-PN-CNT