Risk Adjustment Programs

Telemedicine and Risk Adjustment Programs

Telemedicine and Risk Adjustment Programs

Unconfirmed Diagnosis Code (UDC) Program

The UDC Program is a clinically based program that promotes Provider/Highmark collaboration to evaluate previously reported and/or suspected diagnosis conditions. These conditions require annual evaluation and/or treatment but may not have been reported to Highmark in the current year. This improves continuity, quality and timely coordination of care for chronic conditions.

2021

2020

UDC 5in5 Program 

5in5 Monthly Webinar and Live Q&A session: This 30-minute monthly series is held from 12:15 – 12:45 pm.

2021

2020


2020 Risk Score Accuracy (RSA) Program

The goal of the RSA Program is to help ensure that quality health care is provided to Highmark Medicare Advantage and Inter-Plan Medicare Advantage members with complex chronic health conditions by assisting provider practices to accurately identify, treat, document, and report appropriate diagnosis codes to Highmark.

To support this, analytics are used to identify persistent and/or suspected diagnosis conditions of Members. Participants are asked to address these diagnosis conditions during office visits using an Electronic Medical Record ("EMR")-based or desktop-based, system-generated form ("RSA Tool"). Participants must respond to the RSA Tool, document the confirmed condition in the Member's medical record, and submit confirmed conditions on their claim as indicated in the instructions and Program Manual.


eAWV Program

Using the Vatica Wellness 365+ Software tool, providers can perform enhanced Annual Wellness Visits (eAWV) for their Highmark Medicare Advantage members. The tool assists providers in the appropriate documentation capture of an Annual Wellness Visit while prompting them to also address unconfirmed diagnosis codes. Practices must have a minimum of 100 Highmark Medicare Advantage members to be considered for this program.


Retrospective Chart Retrieval Program

The Retro Program supports a requirement of the Centers for Medicare & Medicaid Services (CMS) to ensure the accuracy and integrity of risk adjustment data submitted to CMS. Highmark works with two vendors, CIOX Health (formerly known as ECS and Healthport) and Verscend, to retrieve charts for a predetermined list of Highmark members from Providers.

CIOX Health 

Verscend 

Last updated on 8/12/2021

 

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