March 25, 2015

 

• Heads Up: Medical Records May be Requested
• CoOportunity Health Membership Update
• Medical Policy Updates
• March Drug List Changes
• April Drug List Changes

 

Under the Affordable Care Act, insurance companies can receive additional funding for providing insurance to members who were sicker and used more healthcare services as part of the risk adjustment program. 

 

To validate that diagnoses were reported, especially for members with chronic conditions, medical records are being requested for approximately 1,000 CoOportunity Health members. A company by the name of RecordFlow will be requesting the medical records.

 

Here's how the process will work.

 

In March, a record retrieval specialist from RecordFlow will call the provider and let the provider know medical records are being requested. RecordFlow will then fax the official medical records request to the provider. The fax will include instructions on how and where to submit the medical records.

 

If your organization is contacted by RecordFlow, please promptly respond to the medical records request. It is important that CoOportunity Health maximizes its risk adjustment payments - especially now that the company is in liquidation and additional funding will help to pay claims and other expenses.

 

Risk Adjustment Data Validation Audit

 

As part of the Affordable Care Act, a new audit is required yearly by all insurers called the Risk Adjustment Data Validation Audit. This audit is to verify that claims submitted to CoOportunity Health match the diagnoses and procedures documented in the medical records. To comply with this CMS mandated audit, CoOportunity Health will be requesting medical records for 200 Iowa members and 200 Nebraska members.

 

If one of your patients is selected for the audit, you will receive a letter outlining the steps to follow to submit the appropriate medical records. This audit will occur in early summer.

 

Your Cooperation is Appreciated   

       

Thank you for promptly responding to these medical record requests. We appreciate your help and cooperation as CoOportunity Health winds down its business.

CoOportunity Health Membership Update

As part of the liquidation process, individual and group members have received notice as to when their CoOportunity Health coverage will terminate. All individual policies will terminate on August 31, 2015. All group policies will terminate on April 14, 2015, except for groups with an April 1, 2015, renewal date. Groups with an April 1, 2015, renewal date will terminate on March 31, 2015.  

        

Continue to Check Eligibility

During this time of transition, please check each CoOportunity Health member's eligibility using one of these options:  

• Use the CoOportunity Health secure Provider website to find answers all day, every day - no waiting.
• Log on 24/7 and enter the ID number, or find an ID number using the patient's name and birth date.
• Contact CoOportunity Health's Member Services for help.
• Follow prompts when you dial 1.888.324.2064, available 24/7. You'll need to enter the patient's ID number and birth date.
• Use the Contact Us tool to direct your question to the correct area. The Contact Us tool includes phone numbers, website resources, and an online form that requests information needed to research your question.
• Call Member Services at 1.888.324.2064 between 7 a.m. and 6 p.m., Monday through Friday.