A newsletter for Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) network providers
Issue 8, August 2023
We do our best to minimize the disruption of medical record requests to your practice as we work to meet continued documentation requirements. Whenever possible, we streamline our outreach to help manage multiple requests.
Highmark Blue Cross Blue Shield of Western New York will be requesting medical records from you on behalf of other Blue Cross Blue Shield and/or Blue Shield Plans when necessary. These requests are generally made for Medicare Advantage patients who are covered by out-of-area Blue Plans, but receive care in New York state.
You may also receive medical record requests from Inovalon 
. The company is authorized to retrieve medical records for out-of-area Blue Plan patients who are covered under Affordable Care Act (ACA) programs and Medicare.
Records are requested in support of Healthcare Effectiveness Data and Information Set (HEDIS®); risk adjustment; government-required programs, including the ACA; Health and Human Services; or Centers for Medicare and Medicaid Services (CMS) star-measure reviews. We ask that you respond to all requests from us and Inovalon.
Timely and effective medical record retrieval is important to ensuring optimal quality reporting and complete and accurate risk scores. Blue Plans participate in medical record retrieval projects year-round. Earlier in the year, you may have received medical record requests regarding these programs:
Currently, the following programs are (or will soon be) requesting medical records:
| Program | Start Date | End Date |
| Medicare Advantage Risk Adjustment (MRA) | April 2023 | December 2023 |
| Commercial Risk Adjustment Data Validation Audit (HRADV) | June 2023 | December 2023 |
| Commercial Risk Adjustment (CRA) (2023 Benefit Year) | October 2023 | April 2024 |
Our vendor, Inovalon, is contractually bound to follow HIPAA (Health Insurance Portability and Accountability Act) regulations and preserve all patient-protected health information (PHI). Medical records may be submitted to Inovalon in the following ways:
If you have questions about delivery options, please call Inovalon at 844-682-9764.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
