Medicare providers may receive requests for chart review

(August 20, 2007) Provider offices may soon be contacted by an employee of SeaCliff Resources, Inc., on behalf of Priority Health. We have hired them to schedule PriorityMedicare^SM patient chart reviews and scan medical records into a secure database. This information will enable us to compare and evaluate the records against the risk scores assigned patients by the Centers for Medicare and Medicaid Services (CMS), which are based on historical claims data.

According to HIPAA, these contracted staff are in a business relationship with Priority Health. Therefore, they are covered under HIPAA as part of the health care operations of Priority Health as it relates to medical records. Please share your patient information with them.

If you have any questions, contact your physician account executive directly or through the Provider Helpline at 616 942-4765 or 800 942-4765.

About CMS Risk Adjustment Factors
CMS calculates and assigns a risk adjustment factor for each patient who receives health benefits through Medicare Advantage-Prescription Drug (MA-PD) plans and Prescription Drug Plans (PDPs). The adjustment factor, or risk score, is based on the member's morbidity. Higher risk adjustment factors are assigned to members who are expected to have more health-related issues. For example, a member who has a risk adjustment factor of 1.2 is 20% more at-risk than a member with a risk adjustment factor of 1.0. CMS sets these risk factors based on the member's historical information recorded in the member's medical record.