Medical Record Retrieval

Improve risk adjustment and HEDIS® results while minimizing provider disruption

The facts

The need for health plans to acquire, exchange, and share member medical record data to support appropriate reimbursement and sustain high-quality member care continues to increase. Despite the widespread adoption and use of electronic medical record (EMR) systems, much of this medical chart retrieval occurs via manual processes requiring faxed requests to providers and the return of medical record images via web portals, fax, and even mail. Successful medical record retrieval requires the ability to deploy many retrieval methods to meet retrieval goals, all while using resources efficiently, reducing turnaround time, and minimizing provider inconvenience.

Cotiviti’s Medical Record Retrieval services streamline medical record retrieval, aggregation, indexing, and storage. With Cotiviti, plans can achieve or exceed their retrieval targets because we use provider weighting algorithms to avoid unnecessary effort; eliminate medical record image transfer downtime; and offer full transparency into retrieval status at the request, project, and provider levels. This is why we consistently exceed the market standard in medical record retrieval.

Benefits

Achieve record retrieval rates typically exceeding 90 percent

Avoid unnecessary medical record retrieval effort and reduce abrasion with provider weighting algorithms

Eliminate medical record image transfer downtime

Gain transparency into retrieval status at request, project, and provider levels

Deep experience drives better results

A dedicated and experienced team is at the heart of Cotiviti’s Medical Record Retrieval services. Our experts have extensive experience in medical record retrieval for a wide range of mission-critical and government-required programs, including:

  • Medicare, Medicaid, and commercial risk adjustment
  • RADV audits
  • HEDIS and other quality initiatives
  • DRG claim overpayment audit and recovery services
  • Life insurance policy underwriting
  • Litigation and discovery

Each staff member receives thorough training on our retrieval management software, provider relations, and chart retrieval best practices.

 

Peak efficiency reduces cost and provider disruption

Our patented record retrieval software and process ensure retrieval efficiency and low provider abrasion:

  • Provider special handling: During implementation, we meet with clients to review and identify “special handling” providers to understand how best to obtain their records.
  • Provider matching: Prior to outreach, we compare provider data within the approved chase list to our Master Record Locator database of 1.7 million unique providers, organizing requests by provider sites and preferred retrieval methods.
  • Request letters: We verify provider requests, create client-specific letters, and send them to each provider facility/site. Multiple requests are sent simultaneously to streamline the process.
  • Retrieval prioritization: Providers/sites are prioritized by volume per site, most recent contact point, and verification that the request lists have been received. We track, store, and manage detailed information about each provider (e.g., contact information, hours of operation, retrieval methods, and record location) to ensure efficient retrieval.
  • Retrieval methods: Providers can send records via fax, mail, and upload to our secure portal or FTP sites, or we can access their EMR directly. We can also go on site, coordinating with third-party copy partners nationwide.
  • Follow-up calls: Our Retrieval Operation Center conducts follow-up phone calls according to specific call procedures to ensure providers respond to requests.
  • Record storage and delivery: Retrieved and indexed medical records are stored in our secure Medical Record Repository. Records are automatically delivered to our proprietary risk adjustment coding or HEDIS abstraction applications with little to no transfer downtime for seamless integration. Digitized records can be viewed directly or delivered to clients through FTP.
  • Reporting: Our account managers have several ways of communicating to clients, including dashboards and detailed reports showing current project status. Authorized client users can also access our systems directly to track progress, view records, and approve excess copy fees.

Improve risk adjustment and HEDIS® results while minimizing provers disruption.

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Results that speak for themselves

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