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Blue Advantage® Medical Risk Reviews

Every year, Blue Cross and Blue Shield of Alabama works to ensure that there is appropriate documentation for our Blue Advantage® members necessary to clarify specific medical conditions. Provider assistance with this effort is very much appreciated as we work to meet the Centers for Medicare & Medicaid Services' (CMS) requirements and standards. This process includes reviewing selected medical records to ensure that our records properly reflect the clinical conditions of our members. This is not an audit, but it is a review of medical records to validate member clinical conditions information we submit to CMS.

We have partnered with Altegra Health, Inc. to conduct these reviews. Altegra Health is in contract with Blue Cross and Blue Shield of Alabama as a business associate covered by the Health Insurance Portability and Accountability Act (HIPAA). Altegra Health is ethically and legally bound to protect the confidentiality of any protected health information it gathers from clinical medical records provided by any of our physicians, hospitals or medical practices.

A letter will be sent to certain offices to provide advance notice of the Altegra Health review. A member of the Altegra Health staff will then contact those offices to discuss the next steps of the process that could include scheduling an on-site review of certain Blue Advantage members' medical records. The Altegra Health staff member will let you know that he/she is with Altegra Health. If contacted, please cooperate with Altegra Health by providing the requested records.

If you have questions, please contact Altegra Health at 1-855-767-2650 (toll free), or you may contact your Blue Cross Provider Network Services Representative at 1-866-904-4130.

Altegra Health is an independent company that provides business, technology and
consulting solutions.

Blue Advantage is a Medicare-approved PPO Plan.

Last Updated June 2015