Solving the Challenge of High-volume Health Plan Chart Requests

The following is a guest article by Steve Mallinak, Senior Vice President of Operations at Ciox.

Every year, healthcare providers receive thousands of health plan chart requests.

From Medicare Risk Adjustment (MRA) requests to HEDIS requests, Affordable Care Act (ACA) records retrieval, RADV, DRG Audit, CIP and QIP: the alphabet soup of chart request types is long, and providers have to fill every request.

The health plans’ demand for records is enough to put a strain on the offices of providers around the country, and the steady flow of requests isn’t letting up any time soon. Medical record requests from health plans will likely grow another 30 percent in the year ahead.  Providers will need to balance the needs of the health plans while still meeting the needs of your patients.

The growth in requests is attributable to the growing need and use for real-world data in a clinical setting. Sharing health information helps support various aspects of the patient/provider relationship, as well as the payer/member relationship.

Of course, for all the benefits of data sharing between insurers and healthcare providers, the flow of data and the fulfillment of the requests themselves are a never-ending, year-round struggle that is only growing larger, longer and more pronounced.

Increased Medicare Advantage (MA) enrollment – up eight percent this year – means more patient records need to be requested and reviewed. And yet, growth in retrieval volume outpaces even the MA growth, a data point that suggests that for each enrollee, health systems must fulfill multiple records requests.

More challenging for providers is where the requests come in. Some come in the form of paper requests; health plans call others in, while others still are emailed or faxed, or requested via one of the many payer portals built and operated by Humana, Aetna, and the others. It would be challenging enough to manage the volume of requests if they were in one place, but instead, they come from every direction.

Luckily there are technology solutions, albeit very few, that solve the heavy lift and enable best practices for the successful fulfillment of health plan chart requests at volume.

At the center of any solution is computer-assisted retrieval. Leveraging a variety of connectivity options from standards-based HL7 to RPA to FHIR, computer-assisted retrieval modules are the flexible, customizable tech integration that doctors’ offices and health systems need to unclog the pile-up of release for information requests.

Imagine every request feeds into a single portal, regardless of whether requested online or via payer portal, fax or other methods. Using a combination of RPA, AI, and machine learning, records are retrieved automatically. A retrieval expert then reviews the entire batch for accuracy and retrieves problematic documents by hand. The result: instead of the workforce doing the retrieving, they review automatically-retrieved records for accuracy.

By instituting a computer-assisted retrieval platform, healthcare organizations can save more than seven hours of processing time per 100 charts. Given the many thousands of chart requests flowing through the organization, the time saved proves nearly incalculable.

With computer-assisted retrieval — or CAR as we’ve taken to calling it at our organization, where we’ve proudly pioneered the advancing technologies that facilitate seamless automated records retrieval — organizations experience a simple, clean flow of information through the system. With the right tools in place to corral, aggregate and streamline requests, healthcare systems can reduce duplicate requests, minimize follow-ups, improve turnaround times, and better protect privacy and security.

Another piece of the puzzle is in the people. Many organizations create a specialized team to handle only health plan chart requests, allowing ROI teams to focus and provide the highest levels of service, alleviate the need for temps, and minimize seasonality because requests are processed continually.

And others still leverage remote processing of health plan chart requests. Remote teams can be more flexible and handle requests from multiple sites, opening up valuable office space that comes at a premium. This approach completely removes the burden from your core team and eliminates distractions from your department.

For those provider organizations partnering with a remote processing team utilizing CAR, the benefit is, on average, a 28 percent reduction in turnaround time.

No matter how your organization approaches health plan chart requests, the key is to build a program with technology and staff that allows for timely fulfillment without disruption to patient care in core ROI processing, and that achieves compliant, accurate and secure exchange.

About Ciox
Ciox Health, a leading health technology company and proud sponsor of Healthcare IT Today, is improving patient health by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale make a difference for healthcare stakeholders and empower greater health for patients. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Learn more about Ciox’s technology and solutions by visiting or Twitter and LinkedIn.