Upcoming MAPD Risk Adjustment Medical Records Request

December 21, 2022

Recently you may have received a request for medical records from Change Healthcare for Medicare Advantage members who used your facility or were treated by your clinical staff during 2021 and 2022.

Change Healthcare, which conducts records retrieval for Blue Cross and Blue Shield of Montana (BCBSMT), is gathering medical records for a Centers for Medicare & Medicaid mandated risk adjustment review.

How do I submit medical records? Submit your records to Change Healthcare using any of the methods below:

  • Secure email: documentationreceipt@changehealthcare.com
  • Fax: 866-667-5557 or 866-686-7771
  • FedEx: Call 855-767-2650 or email CRCR_providerrelations@changehealthcare.com for help
  • Mail paper charts to Change Healthcare, P.O. Box 52122, Phoenix, AZ 85072-2122
  • VPN EMR download: Communicate this preference to Change Healthcare upon receipt of the request letter.
  • Onsite scanning by a Change Healthcare medical record technician

Didn’t I already provide these records? Possibly, because we request medical records throughout the year for different purposes, including:

  • Risk Adjustment – Chart reviews, focusing on accuracy of risk-adjustable codes submitted to CMS
  • Risk Adjustment Data Validation (RADV) – Targeted, plan-specific CMS-mandated chart reviews that ensure payment integrity and accuracy in the risk adjustment program
  • Healthcare Effectiveness Data and Information Set (HEDIS®) measures – Record requests are used to illustrate the completion of specific National Committee for Quality Assurance (NCQA) quality measures

You also may receive medical record requests from Change Healthcare or BCBSMT as part of the Blue Cross and Blue Shield National Coordination of Care program to help close gaps in care for Blue Cross Group Medicare Advantage (PPO)℠ members.

Please note: if your office is enrolled in the Epic Payer Platform, the tax identification numbers associated with that enrollment should not receive records requests. However, there may be outliers where Change Healthcare will need to retrieve any documents we cannot obtain from the Epic Payer Platform.

HEDIS is a registered trademark of NCQA.

Change Healthcare is an independent company that provides administrative services to BCBSMT. Epic is a Health Data Exchange Platform for improved data sharing between BCBSMT members and providers. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors and the products and services they offer.