As of May 13, Blue Cross and Blue Shield of Texas (BCBSTX) may request the medical records of group Medicare Advantage (MA) PPO members from their physicians as part of an effort to close gaps in care, according to the health plan.
The request will come to physicians via mail either from BCBSTX or from the third-party vendor Advantmed. These requests may be for the medical records of BCBSTX members or other group MA PPO members living in Texas and enrolled in national Blue Cross and Blue Shield plans.
Through the health plan’s National Coordination of Care program, physicians do not need patient-authorized information releases to fulfill medical records requests to BCBSTX or to conduct risk-adjustment gap management, the payer says.
BCBSTX says it is collecting this data to identify:
- Risk adjustment and care gaps related to claims submitted to BCBSTX;
- Healthcare Effectiveness Data and Information Set (HEDIS) measures; and
- Data related to the Centers for Medicare & Medicaid Services’ star ratings, which help consumers compare MA health plans based on quality and performance.
BCBSTX asks that physicians “respond quickly to requests related to risk adjustment, HEDIS and other government-required activities as your contract requires.”
For the latest news from major state and federal payers, visit the Texas Medical Association’s Health Plan News page and read Texas Medicine Today.
Last Updated On
May 28, 2024
Originally Published On
May 28, 2024
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469