Blue Cross NC to Collect Medical Records for Medicare Risk Adjustment

Beginning May 11th, 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin to request medical records with dates of service of 1/1/2020 to 12/31/2020 for Medicare Risk Adjustment (MRA).

MRA refers to the process by which Centers for Medicare & Medicaid Services (CMS) adjusts Part C payments made to Medicare Advantage plans to account for expected costs of care based on factors associated with member demographics and health. The goals of risk adjustment are:

1. To collect accurate and complete diagnosis information to ensure proper treatment, care management, and care coordination services.
   
2. To submit accurate and complete diagnosis data to CMS to ensure appropriate payment to both the Medicare Advantage plan and providers – in support of appropriate management of a members’ health.

What we need from you

Once an employee of Blue Cross NC contacts you to obtain medical charts, please respond to the request within five (5) business days.

If you have any questions about this program, please contact George Taylor at 919-765-2750 or George.Taylor@bcbsnc.com.