We're collecting medical records for our Medicare retrospective review
Beginning in the spring, our Risk Adjustment team in partnership with Datavant, a health information technology company, will be contacting select providers to request medical records for our next Medicare retrospective chart review. This review helps us to validate our members’ diagnoses and ensure the risk adjusted payments we receive from the Centers for Medicare and Medicaid Services (CMS) are accurate.
What do you need to do?
If you’re contacted by Priority Health or Datavant, please submit the requested documentation by the deadline provided in your communication.
Submitting documentation
To maximize time and efficiency for your staff and ours, we encourage you to prioritize digital submission methods when sending us medical records, if you’re able. These methods include:
- Remote EMR access (available for select EMRs)
- A secure SharePoint folder: Learn more about how to get set up with a secure SharePoint folder
- Secure email: Email RA@priorityhealth.com for more information
Refer to the communication you receive from Priority Health or Datavant for a full list of submission methods.
Why are we requesting medical records?
CMS requires us to validate diagnoses contained in claims and our members’ medical records, and to submit complete and accurate diagnostic data for each member, each year.
- Authorizations
- Billing & payment
- Procedures & services
- Reviews & appeals
- Drugs
- Medical policies
- Provider forms
- Seeing Cigna members
- Requirements & responsibilities
- Clinical resources
- News
- Fraud, waste & abuse policy
- Join our networks
- Check patient eligibility
- Data exchange
- Set up electronic claims
- Set up electronic funds transfer (EFT)
- Check claim status