02/14/2024

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

HEDIS® Medical Record Review MY2023 Coming Soon!
The Healthcare Effectiveness Data and Information Set (HEDIS) medical record review is an annual retrospective process. It’s an integral part of HAP’s HEDIS reporting. It involves the collection and review of medical records to assess the quality of care provided to our members and your patients. The process is from early February 2024 through early May 2024.

We’ve contracted with Cotiviti, Inc. to retrieve medical records and perform HEDIS medical record data abstraction on our behalf. They will contact your office directly to request copies of chart components. You will be able to send them via fax, mail or an electronic link. They will work with you to minimize disruptions in patient care activities. Cotiviti, Inc. is ethically and legally bound to protect, preserve and maintain the confidentiality of any Protected Health Information (PHI) it gleans from clinical records provided by medical practice locations pursuant to its contractual obligations to HAP defined by the Health Insurance Portability and Accountability Act (HIPAA). Please be assured Cotiviti will treat your patients’ PHI with the utmost protection and confidentiality.

Cotiviti will provide contact information in their letter should you have any questions about the request.

Keep Provider Information Updated in NPPES
It’s important to ensure your data in the National Plan & Provider Enumeration System (NPPES) is accurate. The Centers for Medicare & Medicaid Services (CMS) is encouraging health plans to use NPPES as a resource for online provider directories. By using NPPES database for provider directories, we could decrease the frequency we contact you for this information.

To verify your information, log in at the NPPES website. When reviewing, pay close attention to:

• Provider name
• Mailing address
• Telephone and fax numbers
• Specialty
• Taxonomy

Be sure to remove any practice locations no longer in use and only include addresses where:

• You practice
• You actively see patients
• Patients can call and make an appointment

Reminder – Prior Authorization Requirements and Benefit Coverage Policy Updates
As you know, you can find our prior authorization requirements and benefit coverage policies online. To access the lists, please follow the instructions below.

Prior Authorization Requirements

• Log in at hap.org 
• Select Quick links
• Select Procedure Reference Lists

You can easily search by code to see if an authorization is required. To see changes from the previous month, refer to the Summary of Changes.

Benefit Coverage Policies

• Log in at hap.org 
• Select More
• Select Benefit Admin Manual

You can easily search for policies by a term, code, or phrase. To see changes from the previous month, select Recent Changes.

Reminder - Medical Record Review Projects
HAP partners with vendors to conduct medical record reviews. They contact offices directly and provide the review details, including due dates and submission requirements.

The table below outlines our current and upcoming medical record review projects. All reviews are conducted by our vendor, Change Healthcare, unless otherwise noted. Provider offices could be contacted more than once due to different regulatory projects, dates of service, and membership.