This article is for providers caring for other Blue plans’ Medicare Advantage PPO members who live in Massachusetts.
The Blue Cross Blue Shield Coordination of CareSM program launched nationally on January 1, 2020. This program is designed to maximize the quality of care our Medicare Advantage PPO members receive.
As a part of this program, we’ll work with you to support Medicare Advantage PPO members who live in Massachusetts and receive care from a Massachusetts provider, but have coverage through Blue Cross Association plans from other states.
What are some of the changes I can expect to see as a result of this program?
We’ll offer more information about potential gaps in care and may request additional medical records so that other Blue plans can get a complete understanding of their member’s health. These requests may be related to HEDIS, risk adjustment, or Stars gap closures. We’ll send you additional details based on the type of request you receive.
Will I need to contact other Blue plans?
No, you will not need to contact other Blue plans to close care gaps or submit medical records. If the member’s plan needs any additional information, Blue Cross Blue Shield of Massachusetts will contact you.
Will our practice receive more medical record requests?
We know that you may sometimes receive record requests from different parts of our organization. We try to streamline these requests, but it is not always possible due to different reporting requirements. Please remember that your provider agreement with us requires you to respond to our medical record requests.
How can I identify members in this program?
Members in this program will have the following logo on their ID cards:
Protecting patient privacy
The Health Insurance Portability and Accountability Act (HIPAA) has national standards to protect patients’ personal health information. HIPAA requires us to preserve the confidentiality of health plan members’ protected health information obtained from medical records and provider engagement on Stars and risk adjustment gaps. Read more on how we protect our members’ data.
Questions?
If you have any questions, please contact Risk Adjustment at 1-617-246-3059. As always, thank you for the care you provide to our members.
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