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Optum
Patient Assessment Form (PAF) and Healthcare Quality Patient Assessment Form (HQPAF)
Update on 2017 Program Performance

As most of you are well into your 2017 HQPAF/PAF program, we wanted to provide you with some up-to-date information on how the program is performing overall and how you can possibly improve your results.

Common 2017 Submission Errors

At this point in the year, approximately 11% of the forms submitted to Optum have been rejected, and 6% are still in a rejected status. The top 4 reasons for rejections are listed below:

 
Error Code Error Description % of overall rejects
QR03 Cover Sheet Only 35%
QR05 No Provider Signature 22%
QR 23 Invalid DOS 17%
QR04 Signature Log Needed 11%
 


Your Healthcare Advocate can provide a report to determine if any of your forms have been rejected along with details on corrective actions to take to be able to resubmit those forms. If the original submission was received within the timely filing period, the resubmitted HQPAF/PAF will qualify for full administrative reimbursement if the submission error has been resolved. To avoid further delays in receiving your administrative reimbursement, begin reviewing your rejected forms and resubmit with the error rectified. Resubmissions of rejected forms need to be received by Optum Processing before March 30, 2018. Please refer to the Healthcare Quality Patient Assessment Form (HQPAF)/ Patient Assessment Form (PAF) error code explanations sheet for a list of solutions and submission methods.
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
Phoenix, AZ 85053
HQPAF/PAF Uploader: please visit optumupload.com
Secure Fax:
1‑877‑889‑5747
Now would also be a good time to ensure that you have submitted your signature log, Account Setup Form (ASF) and W-9 to avoid rejections and delays in reimbursement. ASF and W-9 forms need to be received by Optum by the 2017 HQPAF/PAF program year expiration date of January 31, 2018 or your administrative reimbursements for the 2017 HQPAF/PAF program will be forfeited.

Project Year 2017 Quality Gaps Not Closed
(Data as of July 2017)

For the 2017 HQPAF program year, there have been over 15,000 quality gaps not closed due to missing or illegible information on the submitted medical record.

Please ensure that medical record submissions include all data elements required per measure to close gaps as needed. Your local Healthcare Advocate or the Optum Provider Support Center can provide you with several tools that provide guidance on the required elements to close quality gaps. The HEDIS and Five-Star Quality documentation guidelines tool is an example of the tools available to you.

There are a number of new and updated tools to assist you in getting the most out of the HQPAF/PAF program. You can ask your Healthcare Advocate or contact the Optum Provider Support Center for assistance between 8:00 a.m. - 7:00 p.m. EST, Monday – Friday at 1-877-751-9207.

Thank you for your cooperation and participation!

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.

We no longer offer SFTP as an option to submit your Healthcare Quality Patient Assessment Forms/ Patient Assessment Forms (HQPAF/PAF). We encourage you to use our new HQPAF/PAF Uploader; an easier and faster submission method. The HQPAF/PAF Uploader requires less time and effort than preparing and submitting documentation via mail or fax.

The HQPAF/PAF Uploader was developed to provide an interface that allows multiple users to securely submit HQPAFs/PAFs without issue of failed delivery or suspended access. The HQPAF/PAF Uploader:
  • Does not require any user credentials
  • Complies with all HIPAA guidelines to protect your practice and your patient’s personal data
  • Allows anyone in your office to access the site and upload documentation
  • Securely transmits directly to Optum
To get started, please visit: optumupload.com.

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.