Blue Cross Blue Shield of North Dakota (BCBSND) is responsible for the accuracy and integrity of encounter data submitted to the Department of Health and Human Services (HHS) for the Affordable Care Act (ACA). This mandates health plans to review medical records along with claims to assure accuracy of coding practice.
To help us perform these reviews, BCBSND has contracted with Change Healthcare to collect a sample of medical records for services performed in your office in 2023. Change Healthcare began requesting records in late November 2023 and will continue through April 2024. This mandate will not impact all providers and if you are part of the audit, Change Healthcare will be contacting your office to schedule medical record retrieval. They will collaborate with you to determine the best approach for your office and staff.
Providers are permitted to disclose Protected Health Information (PHI) to health plans without authorization from the patient when both the provider and health plan had a relationship with the patient and the information relates to that relationship. Change Healthcare contracted with BCBSND as a Business Associate which is covered by the Health Insurance Portability and Accountability Act (HIPAA). Change Healthcare is ethically and legally bound to protect the confidentiality of any PHI it gathers from clinical records provided by the hospital or medical practice.
Your cooperation in extending Change Healthcare, your professional courtesy and assistance are very much appreciated.
Questions?
If you have questions about any portion of this process, please feel free to contact Change Healthcare’s Provider Relations department at (855) 767-2650 or by e-mail providerrelations@altegrahealth.com.
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