New Medical Record Retrieval Vendor for Out-of-Area Blue Plan Member Records
As you know, under the Affordable Care Act (ACA), carriers such as Blue Cross and Blue Shield of Oklahoma (BCBSOK) must meet certain data submission and coding accuracy standards for “risk adjustment” purposes. To meet these standards, BCBSOK must verify the submissions by reviewing the actual clinical records of members.
Historically, BCBSOK has used the vendor Verscend to retrieve the needed clinical records from our providers for all out-of-area Blue Plan members. The clinical records support the requirements of “risk adjustment” as well as the Healthcare Effective Data and Information Set (HEDIS®) * and other government reporting.
Beginning on January 1, 2018, Inovalon will replace Verscend to retrieve these medical records on behalf of BCBSOK. Please note, as BCBSOK tries to complete the reviews for 2017, you may receive requests from both Inovalon and Verscend up until January 1.
As described in your contractual agreement with BCBSOK, you have agreed to provide copies of medical records upon request. This contractual requirement is not dependent on whether BCBSOK contracts out the record retrieval process. To create greater efficiencies, this is what BCBSOK has done. As you know a HIPAA member authorization is not required for BCBSOK to request these records; however, we want to assure you that BCBSOK has executed a HIPAA compliant Business Associate Agreement with both Verscend and Inovalon that addresses the protection and safeguarding of Protected Health Information.
BCBSOK would like to thank you in advance for providing the designated clinical records within the time frame requested.
Both vendors offer the following convenient methods for submitting the requested records:
- By Fax: 877-221-0604
- By Email: EMRService@inovalon.com (send securely)
- By US or Overnight Mail: Inovalon Document Processing, 7777 Market Center Ave, Suite E, El Paso, TX 79912
- By Electronic submission: Upload the record image to Verscend’s secure portal and enter your password that is included with your Verscend request. Select the files to be uploaded.
- By Fax: 888-231-9601
- By US or Overnight Mail: Verscend, 66 E. Wadsworth Park Dr., Draper, UT 84020
If you have any questions about this memo or about sending medical records to either Verscend or Inovalon, please contact your assigned BCBSOK Provider Network Representative (PNC).
*HEDIS is a registered trademark of NCQA