Medical Record Retrieval

Improve risk adjustment and HEDIS® results while minimizing provider abrasion

CMS RAC

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Health plans need to acquire, exchange, and share large volumes of clinical data to support appropriate reimbursement and sustain quality member care. Despite the widespread adoption and use of electronic medical record (EMR) systems, a multi-modal strategy is required to meet or exceed retrieval goals. A successful retrieval solution operates efficiently at scale and allows health plans to conduct outreach in a coordinated, minimally intrusive manner using a range of options from EMR integration to traditional mail and fax.

>90%
retrieval rate over the past four years

 

Cotiviti’s Medical Record Retrieval solution offers comprehensive, web-based medical record retrieval, aggregation, indexing, and storage. It fulfills even high-volume record requests with minimal disruption to providers and their office staff.

With Medical Record Retrieval, Cotiviti deploys a variety of technical capabilities to meet providers’ preferences for retrieval method and accurate record location. The solution features multiple retrieval options across our database, providing insights critical to meet retrieval goals while reducing provider abrasion. Applications accessed via our client retrieval portal allow clients to track "in progress" requests in real time, view detailed notes and alerts from Cotiviti retrieval agents, and manage post-retrieval project workflows. And artificial intelligence technology creates project efficiencies and empowers a dedicated healthcare chart retrieval team.

Our retrieval clients in risk adjustment and quality benefit from working with a partner committed to accuracy and performance:

>1.5M

unique providers in our proprietary database

<2%

chart not found at location

>4M

records retrieved annually for a wide range of purposes

Medical Record Retrieval solution benefits and features

Our patented record retrieval software and process ensure retrieval efficiency and low provider abrasion, with features that include:

  • Provider insights. Before outreach, we match provider data found within the approved chase with industry data as well as our own extensive database of historical provider data to reflect the most current provider preferences and locations.
  • Configurable retrieval process. Optimize retrieval and prioritize provider requests with a solution that enables you to configure processes for various modes of retrieval. Our fully integrated scheduling and project management system contains detailed provider information that can be tracked, stored, and managed to determine the optimal method for retrieval.
  • Client-facing platform. Applications accessed via our client retrieval portal allow clients to track requests in real time, view detailed notes and alerts from Cotiviti retrieval agents, and manage post-retrieval project workflows.
  • Central record repository. Records are stored within our secure, centralized medical record repository so that users can search for a record and quickly download it to serve multiple needs across your organization.
  • Range of applications. We have extensive experience in medical record retrieval for a wide number of purposes including, but not limited to:
    1. HEDIS reporting
    2. Star Ratings initiatives
    3. Commercial risk adjustment
    4. RADV audits
    5. Clinical chart review

HEDIS® is a registered trademark of the National Committee for Quality Assurance.

Meet retrieval goals and reduce provider abrasion

Our patented record retrieval software and process ensure retrieval efficiency and low provider abrasion. Our streamlined processes include:

  1. Provider special handling. During implementation, we meet with clients to review and identify “special handling” providers to understand how best to obtain their records.
  2. Provider matching. Prior to outreach, we compare provider data within the approved chase list to our Master Record Locator database of more than 1.5 million unique providers, organizing requests by provider sites and preferred retrieval methods.
  3. 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.
  4. 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.
  5. Retrieval methods. Providers can send records via fax, mail, or 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.
  6. Follow-up calls. Our Retrieval Operations Center conducts follow-up phone calls according to specific call procedures to ensure providers respond to requests.
  7. 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.
  8. Reporting. Our account managers have several ways of communicating with 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, including using QR Web for real-time reporting on HEDIS retrieval and abstraction.

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