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Review of medical records is now under way

06/29/2016

We've engaged Inovalon for the 2016-17 review of medical records of both your ConnectiCare Medicare and commercial patients. 

As you know, we must submit detailed documentation for each patient on an ongoing basis to the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS). Records must reflect specific diagnoses following ICD-9-CM/ICD-10-CM standards and be documented in patients' medical charts. 

Inovalon will conduct chart reviews on our behalf from mid-June 2016 through April 2017. Inovalon will contact you to arrange a convenient way of obtaining copies of members’ medical records. The schedule for reviews is: 

  • Commercial: From June 15, 2016, through April 30, 2017, for 2016 dates of service (from Jan. 1, 2016, to Dec. 31, 2016).
  • Medicare: From June 15, 2016, through Jan. 15, 2017, for 2015 dates of service (from Jan. 1, 2015, to Dec. 31, 2015).

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. 

We truly appreciate your help with this effort. Please note, Inovalon serves as ConnectiCare's "business associate" as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Inovalon is required to protect, preserve and maintain the confidentiality of any protected health information (PHI) it obtains from clinical records provided by medical practices.