The WCA Help Desk was alerted about a request that our members were receiving. Yes, it is legitimate and you should respond. WCA Help Desk Director, Tammy McKeown, reached out to Senior Government Relations Director, Wisconsin contact at Blue Cross/Elevance Health for confirmation and explanation of these requests.
Datavant is a vendor engaged by Anthem for the purpose of retrieving records and/or performing reviews of medical charts.
WCA members are receiving the request as part of Anthem’s ongoing obligation to CMS that requires MAOs to attest annually that, based on best knowledge, information, and belief, all risk-adjustment data sent to CMS is “accurate, complete, and truthful.”
It is common practice for providers to furnish requested records so the plan can validate diagnosis data submitted to CMS.
HIPAA expressly permits disclosure of protected health information for “health-care operations,” which include risk-adjustment activities; therefore, no separate patient consent is needed to release records to Anthem or its designees.
All records are transmitted via secure fax or encrypted email and handled under strict privacy and cybersecurity protocols consistent with HIPAA.