AmeriHealth Caritas Ohio works with you to collect complete and accurate member health histories to help facilitate care management, as appropriate. As part of our Risk Adjustment Program, we have contracted with UST HealthProof (UST) to help ensure that medical records for our plan members with chronic health conditions are coded and documented in compliance with Health & Human Services (HHS), Centers for Medicaid & Medicare Services (CMS), or state specific documentation guidelines. UST HealthProof will support providers by providing on-site and remote Provider Engagement Coordination services and conducting retrospective chart reviews.
PEC Program:
The Provider Engagement Coordination (PEC) program uses a Clinical Documentation Improvement (CDI) Alert—delivered in paper or electronic format—to identify potential diagnosis and quality measure gaps. UST will work directly with your practice—either on-site, remotely, or electronically—to support timely and accurate documentation of chronic conditions and member care.
Benefits of the PEC program include:
- Supporting complete and accurate documentation by flagging past or suspected conditions and care gaps for review during patient visits
- Seamless delivery and collection of CDI Alerts through a method that fits your practice (e.g., EMR, secure fax, or on-site)
- Support for accurate risk scores and HEDIS gap closure, helping to improve care coordination and plan quality performance
- Pre-populated alerts with relevant clinical information, reducing the time needed for providers to identify and document historical conditions
- Potential payment for eligible providers that perform chart review who participate in the PEC program and meet program criteria
Retrospective Chart Retrieval and Review:
UST HealthProof will contact providers and facilities directly to retrieve the targeted medical records. Once medical records are retrieved, certified medical coders review medical records to ensure compliance and capture any risk adjustment medical conditions.
Questions
If you have questions about this communication, please contact the Provider Services department at 1-833-644-6001 or your Provider Account Executive. Thank you for your continued support and commitment to the care of our members.
