Have You Received a Records Request Recently?

Are you curious about a records request from Change Healthcare on behalf of Blue Cross Blue Shield? Discover the reason behind it in our informative video! Change Healthcare has been enlisted by BCBSIL to conduct audits mandated by the Federal Government.

Important link for today’s video:

BCBSIL Medical Records Requests Possible

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Transcription:

We hope you’re having a fantastic week, we’ve received a number of phone calls over the last several weeks from doctors concerned about getting a request for records from Change Healthcare on behalf of Blue Cross Blue Shield. So we’ve answered a number of these questions, and we thought it might help if we could give you kind of a quick video explanation as to what is happening with those particular audits.

Now, whenever you get any kind of records request from an insurance company, we always encourage you to read it all, and make sure that you fully understand it. But first of all, these particular records requests are coming from a company called Change Healthcare that has been hired by Blue Cross Blue Shield of Illinois, to perform the audits that are required by the federal government, such as a risk adjustment audits and several other names that go along with those. In those cases, it is important to understand that actually, those audits are not audits of you but instead are the government’s way of ensuring that they’re the information that’s being reported globally by BlueCross BlueShield to them, for their risk pools that they’re insuring to ensure that those numbers and that information is fully accurate. So they hire an independent third party, in this case, Change Healthcare to do these audits to ensure that all of their numbers being reported are accurate.

So please know that when you get these, it is not an audit of you. And it’s it’s not one to lose sleep over or to call your attorney or malpractice carrier, or anything along those lines. But here’s how you know, when you look over the paperwork, you’ll see one of four different typical titles that are listed in that information. One is it’ll say a risk adjustment audit or a risk adjustment. Or it could be a risk adjustment data validation. And the last one you may see is one that is called a health, healthcare Effectiveness Data, and Information Set measures or HEDIS measures. And you’ve heard us talk recently in several different lectures talk about HEDIS measures and their importance, but know that those particular audits are different. They’re not auditing you as a provider.

Now, if you as a provider have done something grossly in error, of course, that will come out in those audits. And those could get reported to a different organization with inside or different department inside of Blue Cross Blue Shield. And if you do get an audit request from the Special Special Investigations Division, that is not a risk adjustment audit, and that’s one to take more seriously and potentially make the appropriate phone calls. But in this case, these are ones that you do need to heed.

Now it’s important you do have to follow through and you do have to provide these records, we recommend two major things one, get that request in writing. Typically, when they send a request, they also send information regarding their authority to be able to request those on behalf of BlueCross BlueShield. When I say they are talking about Change Healthcare. Second is so the first thing is make sure that it is in writing don’t accept any kind of phone call claiming to be Change Healthcare. If they do call, you say just requested they that they put it in writing along with clear information that demonstrates or their authority to be able to request those records. The second major thing is to follow their requests to a tee only send precisely what they’ve asked, but send everything that they’ve asked. And so they’ll typically give you a date range, you want to send that date range. Now if they ask for a date range along with the examination date, you also then want to include that additional examination date as well but only send the information that they’ve requested.

And again, this is not something to lose sleep over. There are risk adjustment audits, and not audits of you as the provider and your records. Hopefully, this information helps you out we’ll catch you next week.