Medical Record Requests for Other Blue Plans

Highmark does its best to minimize the disruption of medical record requests to your practice as we work to meet continued documentation requirements. Whenever possible, we streamline our outreach to help manage multiple requests.

Coordinating Medical Record Retrieval for Other Blue Plans

Highmark will request medical records from you on behalf of other Blue Cross Blue Shield and/or Blue Shield Plans when necessary. These requests are generally made for Medicare Advantage patients who are covered by out-of-area Blue Plans but receive care in Delaware, New York, Pennsylvania, or West Virginia.

You may also receive medical record requests from Datavant. The company is authorized to retrieve medical records for out-of-area Blue Plan patients who are covered under Affordable Care Act (ACA) programs and Medicare.

Records are requested in support of Healthcare Effectiveness Data and Information Set (HEDIS^®); risk adjustment; government-required programs, including the ACA; Health and Human Services; or Centers for Medicare and Medicaid Services (CMS) star-measure reviews. We ask that you respond to all requests from us and Datavant.

Medical Record Retrieval – A Year-Round Process

Timely and effective medical record retrieval is important to ensuring optimal quality reporting and complete and accurate risk scores. Blue Plans participate in medical record retrieval projects year-round. Earlier in the year, you may have received medical record requests regarding these programs:

• Commercial Risk Adjustment (CRA) – 2025 Benefit Year
• Medicare Advantage Risk Adjustment Data Validation (RADV)
• HEDIS

Currently, the following programs are (or will soon be) requesting medical records:

Working with Datavant

Datavant is contractually bound to follow HIPAA (Health Insurance Portability and Accountability Act) regulations and preserve all patient-protected health information (PHI).

Medical records may be submitted to Datavant in the following ways:

• Mail: Mark Confidential on the envelope and mail the medical records to: 
  • Datavant
    2222 W. Dunlap Ave
    Phoenix, AZ 85021 

• Fax: 972-848-7690
• Secure email to ChartReview@datavant.com

If you have questions about delivery options, please call Datavant at 877-445-9293.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).