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Quality – HEDIS/NCQA Updates for Providers, Winter 2019

Oct 30, 2019
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Important information on the Risk Adjustment program

Risk Adjustment Update

Closing gaps in care for Members identified with potential high-risk conditions is part of our ongoing Risk Adjustment efforts. This work includes outreach to targeted Members to encourage them to see their PCP before the end of 2019 and sending Gap Closure Forms to relevant providers. If your office receives these forms, please complete and return them as soon as possible following the office visit.

This year Health Options has partnered with Datafied to assist with Risk Adjustment medical record retrieval. If your office is contacted, you will be asked to send medical records as instructed on the request form. If you have already sent your records, thank you for your cooperation.

If you have any questions regarding Risk Adjustment, please reach out to Deidre DeRoche, Manager, Government Programs at dderoche@healthoptions.org.

SEE ALSO

Detailed information on claims submission pathways and requirements, replacement claims, claims reconsiderations, and new addresses for submitting appeals and reconsiderations.