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

Jan. 23, 2018

Under the Affordable Care Act (ACA), Blue Cross and Blue Shield of Montana (BCBSMT) must meet certain data submission and coding accuracy standards for "risk adjustment" purposes. To meet these standards, BCBSMT must verify the submissions by reviewing the actual clinical records of members.

Historically, BCBSMT has partnered with Verscend to retrieve the needed clinical records from our providers for all out-of-area Blue Plan members. The clinical records support the requirements of "risk adjustment" as well as the Healthcare Effective Data and Information Set (HEDIS®) * and other government reporting. As of January 1, 2018, Inovalon has replaced Verscend as our partner to retrieve these medical records on behalf of BCBSMT. BCBSMT would like to thank you in advance for providing the designated clinical records within the time frame requested. Inovalon offers the following convenient methods for submitting the requested records:

  • By Fax: 877-221-0604
  • By Email: (send securely)
  • By US or Overnight Mail: Inovalon Document Processing, 7777 Market Center Ave, Suite E, El Paso, TX 79912

If you have any questions about this memo or about sending medical records to Inovalon, please contact your assigned BCBSMT Provider Network Consultant.

*HEDIS is a registered trademark of NCQA

Inovalon partners with Health Plans across the nation to provide logistical capabilities for medical record collection and data abstraction in order to improve clinical diagnosis data accuracy and risk score accuracy. If you have any questions about the products or services provided by Inovalon, you should contact the vendor directly at 800-390-3180.