November 2018
Reminder: Respond to Medical Record Retrieval Requests from Inovalon
As previously mentioned in the Blue Review, Inovalon was selected to retrieve medical records for out-of-area Blue members starting Jan. 1, 2018, to support Healthcare Effectiveness Data and Information Set (HEDIS®), risk adjustment and government required programs related to the Affordable Care Act (ACA).
Inovalon is an experienced health care analytics company. The vendor will provide a centralized process to coordinate medical record requests from Blue Cross and Blue Shield companies across the country and help reduce multiple requests for patient data.
Effective medical record retrieval services play a fundamental role in helping to drive optimal quality reporting outcomes and appropriate risk scores.
Blue Cross and Blue Shield Plans will initiate their annual projects as follows:
| Project | Start Date | End Date |
| HEDIS | January 2019 | May 2019 |
| Medicare Risk Adjustment (MRA) | May 2019 | December 2019 |
| Health Risk Adjustment Data Validation (HRADV) | June 2019 | December 2019 |
| Commercial Risk Adjustment/Risk Adjustment Data Validation (CRA/RADV) | January 2019 | December 2019 |
As outlined in your contract, you are required to respond to requests in support of risk adjustment, HEDIS and other government-required activities within the requested timeframe. This includes requests from Inovalon on our behalf. Blue Cross and Blue Shield of Illinois (BCBSIL) is working diligently to make this process as simple as possible.
For your convenience, medical records may be submitted to Inovalon in the following ways:
- Phone – 844-682-9764 (for questions on delivery options/methods)
- Fax – 877-221-0604
- FedEx – For further instruction on returning records via FedEx, please call 800-463-3339
- Email – EMRService@inovalon.com (send secure)
HIPAA/Privacy
Inovalon is contractually bound to preserve the confidentiality of health plan members’ protected health information (PHI) obtained from medical records, in accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. Please note that patient-authorized information releases are not required in order for you to comply with these requests for medical records.
Providers are permitted to disclose 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 the relationship [45 CFR 164.506(c)(4)]. For more information regarding privacy rule language, please visit hhs.gov/ocr/privacy.
If you have any questions, please do not hesitate to contact BCBSIL and/or your Provider Network Consultant (PNC).
Inovalon is an independent company that has been contracted to provide medical record collection retrieval services for BCBSIL. Inovalon is wholly responsible for their own products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by Inovalon.
HEDIS is a registered trademark of NCQA