Medical record reviews started in June

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Medical record reviews started in June


From now through December, you may receive separate requests from Inovalon and/or Health Data Vision, Inc. to review the medical records of your patients who have ConnectiCare Medicare Advantage or commercial plans.

Inovalon, which has done previous outreach for us, will conduct chart reviews of dates of services in 2016 for both our commercial and Medicare Advantage plans.

We must submit accurate and complete member diagnosis data to the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). Inovalon will call your offices to coordinate a convenient chart retrieval method and specify the date by which records must be received.

Health Data Vision, Inc. (HDVI), will also contact some provider offices to retrieve, review and submit the medical records for members identified by CMS as part of the annual audit of ConnectiCare.

CMS conducts an annual audit to verify the accuracy of diagnosis data that health plans submit to HHS. We are required to submit supporting medical records on CMS’ audit population. HDVI will call your offices to coordinate a convenient chart retrieval method and specify the date the records must be received.

Please respond to HDVI’s and Inovalon’s request for records promptly.

As our partners and “business associates,” as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), both HDVI and Inovalon are fully HIPAA compliant and are required to protect, preserve and maintain the confidentiality of any protected health information (PHI) obtained from clinical records provided by medical practices.

We truly appreciate your help with these medical record reviews. If you have questions, please call a ConnectiCare provider education and service representative at (860) 409-2468. Notice of the need for these reviews and your required compliance are included in your contractual agreement with ConnectiCare.