We're collecting records for our Medicare retrospective chart review
Beginning April 22, our Risk Adjustment team in partnership with Datavant, a health information technology company, will be contacting select providers to request medical records for our Medicare retrospective chart review. This review helps us to validate our members’ diagnoses and ensure the risk adjusted payments we receive from the Centers for Medicare and Medicaid Services (CMS) are accurate.
What do you need to do?
If you’re contacted by Priority Health or Datavant, please submit the requested documentation by the deadline provided in your communication.
Submitting documentation digitally
To maximize time and ensure efficiency, we encourage providers to prioritize sending us records digitally, if they’re able. Digital methods include:
- Remote EMR access
- A secure SharePoint folder
- Secure email
Providers will find a full list of submission methods in the records request communication they receive from Priority Health or Datavant.
Why are we requesting medical records?
CMS requires us to validate diagnoses contained in claims and our members’ medical records, and to submit complete and accurate diagnostic data for each member, each year.
- Authorizations
- Billing & payment
- Procedures & services
- Reviews & appeals
- Drugs
- Medical policies
- Provider forms
- Seeing Cigna members
- Requirements & responsibilities
- Clinical resources
- News
- Fraud, waste & abuse policy
- Join our networks
- Check patient eligibility
- Data exchange
- Set up electronic claims
- Set up electronic funds transfer (EFT)
- Check claim status