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Medical Record Requests for Quality Rating System Measures

Blue Cross Blue Shield of North Dakota (BCBSND) is required by the Centers for Medicare & Medicaid Services (CMS) to submit Quality Ratings System (QRS) information for our Qualified Health Plans. In addition, BCBSND submits QRS information for our commercial business as a requirement for URAC Health Plan accreditation. Some QRS measure data is obtained from medical records.

Cotiviti has been contracted to gather medical records on behalf of BCBSND and is contractually bound to preserve the confidentiality of health plan members’ protected health information (PHI) obtained from medical records, in accordance with HIPAA regulation {45 CFR 164.506 (c) (4)}. BCBSND also performs an annual security review of Cotiviti. Please note patient-authorized information releases are not required in order for you to comply with this request.

You can expect to receive medical record requests from Cotiviti beginning in March 2022. Your Participation agreement with BCBSND requires you (and your contracted vendor) to allow BCBSND, and its contracted vendor Cotiviti, access to and copies of a member’s records upon request and at no cost. The requested medical records must contain the patient’s name, patient date of birth, name of provider and service date(s).