CDPHP Providers Important Information - Medicare Modernization Act Means Document Submission

Recently, CDPHP contacted its providers to inform them that the Centers for Medicare and Medicaid Services (CMS) has implemented a risk-adjustment methodology for all Medicare Advantage beneficiaries. As part of their participation in the Medicare program, CDPHP is obligated to submit all documented ICD-9-CM codes associated with provider's patients who are members of their Medicare Advantage health plans to CMS on an annual basis.

CDPHP is partnering with Altegra Health, Inc., a health care consulting services firm, in a data collection process that will be initiated in the near future. Be assured that this effort is not an audit; the data is needed for CMS and CDPHP to get an accurate picture of health status of their Medicaid members.

If you are a CDPHP provider, you may receive a call from a representative of Altegra Health, who will share further details about this project. CDPHP assures that this will be done with as little disruption to your practice as possible. Records may be scanned onsite or sent back to Altegra Health via fax.

Furthermore, CDPHP has entered into a Health Insurance Portability and Accountability Act (HIPAA) Business Associate Agreement with Altegra Health for this purpose. Accordingly, the release of this information to Altegra Health is permissible under HIPAA. Altegra Health maintains the security of data as required under HIPAA and its Business Associate Agreement with CDPHP.

If you are a CDPHP Provider, and you have any questions about this project, contact the CDPHP Provider Services Department at 1-800-926-7526 or 1-518-641-3500.