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Optum
Healthcare Quality Patient Assessment Form (HQPAF) and Patient Assessment Form (PAF)
Update on 2018 Program Performance

Now that the Healthcare Quality Patient Assessment Form (HQPAF)/Patient Assessment Form (PAF) program year is halfway through, it is a great time to review available reports to assess your group’s performance. The Provider Scorecard is a great tool to help track your group’s HQPAF/PAF performance at an aggregate level. Items discussed on the scorecard include:

  • Year-over-year membership
  • Risk Score for your group
  • Percentage of HCC recaptured
  • Diagnosis Prevalence percentages


A sample of the Provider Scorecard can be accessed here. Please contact your Healthcare Advocate to review and discuss your group’s scorecard in depth.

Common 2018 Submission Errors

In 2018, approximately ten percent (10%) of the forms initially submitted to Optum were rejected, and six percent (6%) remain in a rejected status. The most common Reject reasons are listed below:

 
Error Code Error Description % of overall rejects
QR03 Cover Sheet Only 34%
QR 23 Invalid DOS 18%
QR05 No Provider Signature 13%
QR04 Signature Log Needed 7%
 


Did you know …

Your Optum Healthcare Advocate or the Provider Support Center can provide access to a number of tools to assist you in tracking your participation in the program. Please contact your Healthcare Advocate or Optum’s Provider Support Center at 877‑751‑9207 or via email at providersupport@optum.com with any questions.

To minimize errors, or to correct previously rejected forms, please refer to the HQPAF Checklist and FAQ for Providers.

Remember …

PAF/HQPAF must be
submitted via:

Traceable carrier (any commercial carrier with traceable delivery) to the following address:
Optum – Prospective Programs Processing
15458 North 28th Avenue, Suite G
Phoenix, AZ 85053
PAF Uploader: please visit optumupload.com
Secure Fax:
1‑877‑889‑5747
Your Healthcare Advocate can provide a report to determine if any of your forms have been rejected along with details on corrective actions to enable resubmission of those forms. If the original submission was received within the timely submission period (60 days from the date of service), the resubmitted HQPAF/PAF will qualify for full administrative reimbursement only after the Reject reason has been resolved. To avoid further delays in receiving your administrative reimbursement, review, resolve and resubmit your rejected forms as soon as possible. Reject resubmissions need to be received at Optum Processing before March 29, 2019. Please refer to the Healthcare Quality Patient Assessment Form (HQPAF)/ Patient Assessment Form (PAF) Error Code Explanations Sheet for additional information on Rejects.

Additionally, now is a good time to ensure that you have submitted your signature log, Account Set-up Form (ASF), W-9 and that you have enrolled in direct deposit to avoid rejections and delays in reimbursement. Direct deposit enrollment, as well as completed ASF and W-9 forms, need to be received at Optum by January 31, 2019. Administrative reimbursement pending due to failure to submit an ASF/W9 and/or enroll in direct deposit may be at risk.

For further assistance, please contact your Healthcare Advocate or the Optum Provider Support Center between 8:00 a.m. – 7:00 p.m. EST, Monday – Friday at 877-751-9207.

If you have any questions about the PAF or HQPAF programs, please contact your local Optum Healthcare Advocate or the Optum Provider Support Center between 6:30 a.m. – 4:30 p.m. PST, Monday – Friday, at 1‑877‑751‑9207 or email us here.

Thank you again for your participation in the Optum Patient Assessment Form (PAF) and the Healthcare Quality Patient Assessment Form (HQPAF) programs.

For additional information as well as publications and products available for HEDIS®, please visit the National Committee for Quality Assurance (NCQA) website at ncqa.org.

For additional information about the Medicare Advantage Five‑Star Quality Rating System, please refer to: http://go.cms.gov/partcanddstarratings.

Optum® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer.

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