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Provider Digest | Issue 16

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Don’t miss these dates: Care-Based Incentives, data validation audit

2023 DHCS encounter data validation audit

Starting Feb. 1, 2023, the Health Services Advisory Group (HSAG) is conducting their annual Department of Health Care Services (DHCS) encounter data (claims) audit.

The audit study period is Jan. 1–Dec. 31, 2021. During the audit, HSAG will look for encounter data completeness and accuracy through medical record review.

The Alliance will begin contacting provider offices to request medical records in the beginning of February.

Providers will need to submit the following medical records:

  • HSAG will randomly select one date of service (DOS) in the study period. Providers will need to submit the medical record for that DOS.
  • Providers will be required to select a second DOS closest to the sample DOS, with the same rendering provider when possible, and submit that medical record.

Note: This audit will occur simultaneously with the Healthcare Effectiveness Data Information Set (HEDIS) audit. This means that provider offices may be receiving multiple medical record requests from the Alliance. However, the sample population and audit period will be different. We thank you for your office’s time and cooperation in submitting the requested information!

Best practices:

  • We request that all medical records be returned within 5-7 business days of the request.
  • For paper charts, please apply a provider signature stamp next to handwritten provider signatures.

Questions?

If you have any questions regarding the HSAG encounter data validation audit, please email us at [email protected].

Feb. 15 feedback session: proposals for CBI, Provider Portal

Primary care providers, office managers and quality improvement staff, your feedback is needed! Join us for a review of proposals for the Care-Based Incentive Program and Provider Portal for 2024.

Wednesday, Feb. 15, 2023
Noon-1 p.m. on Microsoft Teams (online)
Register

Speakers include:

  • Alliance Medical Director Dr. Dianna Diallo.
  • Alliance Quality Improvement Program Advisor Alex Sanchez, MPH.

Your input is key to CBI success and we thank you for sharing your insights and ideas with us.

During the session, we will discuss:

  • What’s staying the same in 2024.
  • Proposed new measures.
  • Proposed measures for retirement.
  • Proposed enhancements to the Provider Portal.

Register for the event online or contact your Alliance Provider Services Representative at 800-700-3874, ext. 5504.

If you have questions about the CBI program, please email us at [email protected].

Submit 2022 CBI data by Feb. 28

The deadline is quickly approaching! Please submit your 2022 Care-Based Incentive (CBI) data by Feb. 28, 2023. The Data Submission Tool (DST) is available on the Alliance’s Provider Portal under “Data Submissions.” This tool allows providers to submit data from electronic medical records and paper records to qualify for CBI and HEDIS measures.

Measures you can submit data for include:

  • Alcohol Misuse Screening and Counseling.
  • BMI Assessment: Children and Adolescents.
  • Breast Cancer Screening (screening and mastectomies).
  • Cervical Cancer Screening (pap and HPV screenings and hysterectomies).
  • Child and Adolescent Well-Care Visits (0-21 years).
  • Chlamydia Screening in Women.
  • Colorectal Cancer Screening (new DST type for submission).
  • Controlling High Blood Pressure.
  • Developmental Screening in the First 3 Years.
  • Diabetic HbA1c Poor Control >9%.
  • Application of Dental Fluoride Varnish.
  • Immunizations: Adults.
  • Immunizations: Adolescents.
  • Immunizations: Children (Combo 10).
  • Initial Health Assessment.
  • Screening for Depression and Follow-Up Plan (new DST type for submission).
  • Unhealthy Alcohol Use in Adolescents and Adults.

COVID-19 immunization submissions

The Alliance is accepting COVID-19 immunization submissions via the DST using the immunization file layout and test type. Submissions will be included in the Provider Portal Quality Report.

Tips for successful submissions

  • If your file was previously rejected: please review the reason for rejection and resubmit after correction. If you have questions about why the file was rejected, please call your Provider Relations Representative at 800-700-3874, ext. 5504.
  • For step-by-step instructions on how and what to upload for each measure: Review the Data Submission Tool Guide in the Provider Portal. If you have questions about the DST, please email [email protected].

You will receive an email confirmation within one business day of your data submission.

Submitting 2023 Colorectal Cancer Screening data

As of Jan. 10, 2023, providers can submit Colorectal Cancer Screening data through the Data Submission Tool in the Alliance Provider Portal. Colorectal Cancer Screening is an exploratory measure included in our 2023 Care-Based Incentive program.

Measure description

The percentage of members 45-75 years of age who had appropriate screening for colorectal cancer.

Measure resources

Please see the 2023 Care-Based Incentive Technical Specifications for more details. The Colorectal Cancer Screening Tip Sheet includes best practices for increasing screening rates, coding requirements and data submission tips.

If you have questions about the Data Submission Tool, please email [email protected].

Why Colorectal Cancer Screening is important

Of cancers that affect both men and women, colorectal cancer is the second leading cancer killer in the United States, but it does not have to be. Treatment for colorectal cancer in its earliest stage can lead to a 90 percent survival rate after five years.

However, more than a third of adults 50–75 do not get recommended screenings. Colorectal cancer screening of asymptomatic adults can catch polyps before they become cancerous or detect colorectal cancer in its early stages, when treatment is most effective.