NextBlue Medicare Advantage is informing our provider community that our partner Arkos Health is requesting records on behalf of NextBlue through Reveleer. Reveleer has a business associate agreement with Arkos and, as such, is bound by applicable federal and state privacy and confidentiality requirements in conducting this activity on behalf of Arkos. Any information shared during this review will be kept in the strictest of confidence, in accordance with all applicable State and Federal laws regarding the confidentiality of patient records, including current HIPAA requirements.
Reviewing medical records is a key component of the Medicare risk adjustment process to supply accurate data to the Centers for Medicare and Medicaid Services (CMS). It enables us to identify conditions that you may have noted in the progress notes, but were:
- Not included on the claim at the time of the visit
- Not coded to the highest degree of specificity at the time of the visit
Accurately documenting active chronic conditions helps to ensure the best health management outcomes for your patients, as these types of conditions are known to impact patient’s overall health risk status. Our goal is to ensure high quality health care for our members and accurately report data to CMS.
Please note this is not a payment audit.
Providers are expected to send requested medical records within 14 business days of this notice. If you have questions about risk adjustment chart reviews, please contact Reveleer Provider Relations at 1-855-454-6182.
Thank you for the care you provide our members and your full cooperation in providing these medical records.
Questions?
Contact Nextbluepartners@bcbsnd.com.
