AdvantMed - Medicare and Marketplace Line of Business – Risk Adjustment Chart Review Request
9/29/2023
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Posted by Provider Relations
Fidelis Care and Wellcare By Fidelis Care are pleased to inform you that we have contracted with the vendor, AdvantMed, to assist in facilitating the retrieval of medical records for our Risk Adjustment Retrospective Chart Review program. We appreciate your cooperation with any chart review efforts.
- These programs utilize chart review to look back in time for missing data.
- This allows Fidelis Care and Wellcare By Fidelis Care to meet the New York State Department of Health requirement that health plans submit complete diagnostic information regarding their members.
- To meet this requirement, we are requesting your cooperation to facilitate standard and routine chart review for your patients enrolled in Fidelis Care throughout the year for various products (Medicare and Marketplace).
- The goal of the Chart Review program is to close risk and care gaps where additional coding opportunities exist and to ensure that members’ conditions are coded to the highest specification.
- The programs are administered by vendors on behalf of Fidelis Care and Wellcare By Fidelis Care, members of the Centene Corporation. Vendors retrieve targeted charts from providers. You will receive an outreach letter from our vendor with a list of the charts we are looking for you to submit. There are various ways you can submit the charts, which will be outlined in the letter.
- Charts are selected based on suspected unreported conditions for a member.
- Coders then review medical charts to identify and report diagnosis codes that were not identified on the claim.
If you have any questions, please contact your Fidelis Care Provider Partnership Associate.