Individual and Small Group Metallic Plans Chart Chase Program

May 30, 2023
Individual and Small Group Metallic Plans Chart Chase Program

QualChoice is required by the Centers for Medicare & Medicaid Services (CMS) to submit complete diagnostic data regarding members enrolled in our individual and small group metallic health plans.

As a valued part of our provider network, your cooperation and support in facilitating a medical record review is key to gathering this information.

We have partnered with Change Healthcare, Datafied, and Ciox® to conduct the medical chart review. A representative from one of these vendors will work with you to provide retrieval options and a list of the requested members’ medical records.

QualChoice now offers a bidirectional feed into your Electronic Medical Record (EMR) to help increase efficiency and accuracy in closing care gaps. If you are currently using Healow, Epic, Meditech, Oracle Cerner®, or Veradigm® (formerly Allscripts), email our risk adjustment team at for details about this new tool. You can also contact them for information about our other programs, as well as questions about ICD-10 coding and documentation.

Want to learn more about risk adjustment? Visit our For Providers page at to access helpful forms and information.