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New Medical Record Retrieval Vendor for Out-of-area Blue Plan Member Records

Posted October 5, 2017

The “risk adjustment” requirement under the Affordable Care Act (ACA) requires Blue Cross and Blue Shield of Illinois (BCBSIL) to meet data submission and coding accuracy standards. Member medical records are necessary to help ensure that these requirements are satisfied.

Currently, BCBSIL works with Verscend to retrieve medical records for all out-of-area Blue Plan members to support Healthcare Effective Data and Information Set (HEDIS®), the risk adjustment requirement under ACA and government programs.

Effective Jan. 1, 2018, Inovalon will replace Verscend as the new medical records retrieval vendor. Between now and Jan. 1, 2018, you may see requests from both Verscend and Inovalon as the transition is completed on Jan. 1, 2018. 

Both Verscend and Inovalon are independent companies and contractually bound to preserve the confidentiality of members’ protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. Please note that patient authorized forms are not required for disclosures of members’ medical records to Verscend or Inovalon.

As set forth in your Agreement with BCBSIL, you are required to respond to requests for medical records from BCBSIL. Such compliance is also required for requests for medical records from BCBSIL’s designees, such as Verscend and Inovalon, in support of risk adjustment, HEDIS and government programs within the requested timeframe. BCBSIL is working diligently to ensure this process is followed.

For your convenience medical records may be submitted in the following ways:

Inovalon

  • Fax:  877-221-0604
  • Email: EMRService@inovalon.com (send secure)
  • Mail: Inovalon Document Processing, 7777 Market Center Ave, Suite E, El Paso, TX 79912

Verscend

  • Upload the record image to Verscend’s secure portal and enter your password that is included with your Verscend request. Select the files to be uploaded.
  • Fax: 888-231-9601
  • Mail: Verscend, 66 E. Wadsworth Park Dr., Draper, UT 84020

Providers are permitted to disclose PHI to BCBSIL without authorization from the member when both the provider and BCBSIL have or had a relationship with the member and the information relates to the relationship.  See 45 CFR 164.506(c)(4). For more information regarding the HIPAA Privacy Rule, please visit hhs.gov/ocr/privacy.

If you have any questions about sending medical records to Verscend or Inovalon, contact your assigned Provider Network Representative (PNC).

HEDIS is a registered trademark of NCQA