Reducing Risk Adjustment and Stars Care gaps for out-of-area group Medicare Advantage PPO members

As of Jan. 1, 2020, the Blue Cross and Blue Shield Association (BCBSA), an association of Blue Cross Blue Shield® Plans, started a new approach to care management for out-of-area group Medicare Advantage members.

This new arrangement enhances the way Blue Plans support Medicare Advantage group members who live outside their designated service area.

What does this mean?

Other Blue Plans will engage Blue Cross Blue Shield of North Dakota (BCBSND) to connect with providers to close risk adjustments / Stars gaps and to request medical records as needed for their members living in our service area. BCBSND will be reaching out via letter, phone or email regarding the details of these requests.

Learn more

BCBSND will send out quarterly education through HealthCare News on care coordination for the following topics:

  • Expectations for gap closures
  • Member experience expectations that relate to CAHPS/HOS surveys
  • Performance metrics & tools for tracking performance
  • New vendor agreements
  • Importance of coding accuracy
  • The basics of risk adjustment
  • Education on the necessity of annual wellness visits and physicals

Watch for further communication on these requests. If there are questions about the program or how to access the reports, please email us at