Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Press Releases
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2017

ACA Risk Adjustment Data Validation: Medical Chart Requests


The U.S. Department of Health and Human Services and Massachusetts Health Connector (the federal and state agencies administering the Affordable Care Act’s risk adjustment program) are required to annually validate the accuracy of claims data submitted by health insurance companies for risk-adjustment-covered-plans through the validation of members’ medical records. This process is known as the Risk Adjustment Data Validation (RADV) program.

In support of the program, beginning in June 2017, you may receive a medical chart request pertaining to services provided to your Harvard Pilgrim patients during the 2016 calendar year, as part of the annual RADV audit. Please keep in mind that:

  1. Medical chart requests may be for a regular patient of yours or someone who was only seen once in your office
  2. Medical charts must have the patient’s name and date of birth, the date of service, the provider’s signature and credentials, and date of the provider’s signature
  3. Medical charts must be provided within 14 days to meet Harvard Pilgrim’s audit timeline requirements
  4. Member authorizations are not required
  5. Medical chart request materials will include contact information for the entity collecting charts, as well as a Harvard Pilgrim phone number and email for any additional assistance

If you have questions regarding a RADV medical chart request, please contact Kathryn Roach, Program Manager, at 617-509-2199.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

GIC Product Updates Effective July 1

CLINICIAN CORNER

Medical Drug Prior Authorization Program with CVS Health–NovoLogix

Reminder: CVS Specialty is New Preferred Specialty Pharmacy

Update to ExMI Therapy for Urinary Incontinence Medical Policy

Update to Infliximab Medical Review Criteria

Fecal Microbiota Transplantation Medical Policy Updated

Reducing Preventable Readmissions in the Medicare Advantage Population

Non-Medication Alternative Treatments for Chronic Pain

ACA Risk Adjustment Data Validation: Medical Chart Requests

Robust Discussion at Massachusetts Medical Directors’ Meeting

OFFICE ASSISTANT

2017 Home Care Seasonal Flu Vaccine Fee Schedule

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator