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Optum
Healthcare Quality Patient Assessment Form (HQPAF) and Patient Assessment Form (PAF)
Gearing up for success

On behalf of the Health Quality Assessment Form (HQPAF)/Patient Assessment Form (PAF) program, we would like to thank all providers for the ongoing cooperation to help improve the care of patients by offering outstanding service and closing gaps in care. We hope that for the 2018 HQPAF/PAF program year, we continue to work together to improve care for patients. Optum’s goal is to help you deliver better health care. Routine exams and screenings can help you identify and detect chronic conditions often before patients have any symptoms. The HQPAF/PAF program is designed to help physicians conduct a comprehensive exam. As you prepare to complete your HQPAFs/PAFs encourage your patients to schedule their annual exam.

Don’t forget HQPAF/PAF is a tool that Optum provides for you to provide risk adjustment and HEDIS information with health plans and ultimately CMS. Optum offers additional reports; clinical education and tools that will help support your success in this program. Some of these reports include the suspected diagnosis’ that are located in the ongoing assessment and evaluation section of the HQPAF/PAF. Speak to your Healthcare Advocate (HCA) about gaining access to these reports.

Provider cooperation is imperative for the success of HEDIS and Star Ratings and other quality improvement programs. To assist in successful closure of quality measures, we have included a summary of quality measure outcomes for the 2017 HQPAF/PAF program year (data through February 2018) highlighting gaps closed and some of the reasons why other gaps remained open.

Total Medicare quality gaps closed for all measures during the 2017 Program Year: 754,581
  –   Measures with most quality gaps closed during the 2017 Program Year were:
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
  • Colorectal Cancer Screening: 259,495
  • Controlling High Blood Pressure: 181,626
  • Spirometry Testing: 77,410
  –   Measures with the most HEDIS Exclusions during the 2017 Program Year were:
  • COA – Advanced Care Planning: 722
  • Diabetes – Eye Exam: 349
  • Diabetes – Nephropathy Screening: 102
  –   Reasons for quality gaps remaining open during the 2017 Program Year:
  • Instances in which the quality measure information was not found in medical record submitted by provider:
    • 187,583
  • Instances in which the quality measure information was not validly documented in medical record or lab record submitted by provider:
    • 41,033
  • Instances in which the quality measure information contained a date of service out of range for the measure in the medical record submitted by provider:
    • 16,589
  • Instances in which the quality measure information did not contain a valid HEDIS exclusion in the medical record submitted by provider:
    • 16,351
  • Instances in which the quality measure information was missing the date of service in medical records submitted by provider:
    • 14,736
Optum provides health data for over 60 million Americans – helping them and improving the performance of the health system. Talk to your HCA about your EMR system and ways to capture HEDIS measures easier.

Annual Entitlement Review

This is that important time of the year in which we ask that you take another look at your provider rosters and make any necessary updates or changes. If your provider group accesses HQPAFs/PAFs via OptumPAF or InSite, please log in and ensure you complete the Physician Entitlement Review. This allows you to decide which physicians for which you want to receive HQPAFs/PAFs. This review should be continuously conducted to ensure accurate delivery of HQPAFs/PAFs. Please take a minute and complete the initial entitlement review so you can begin to receive your 2018 patient assessment forms.

The beginning of the year is also a great time to take a minute with your HCA to review your Account setup form and make any necessary changes before a new patient assessment program year begins. Should changes need to be made to the location or tax ID #, please reach out to your HCA or the Provider Support Center so we can get those changes made.

Update: 2017 Reject resubmissions will be accepted through Monday, April 30th.
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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