Correct Rejected Forms

When an HQPAF/PAF submission does not comply with the program’s guidelines, a rejection code is applied. As of October 12, 2018, 52% of rejected HQPAFs/PAFs remain in a rejected status nationally. Rejected forms cannot be processed and administrative reimbursement, if applicable, cannot be issued. Most rejections can be easily resolved to permit processing. The top reasons for HQPAF/PAF rejections are:

• Coversheet only - Only the HQPAF/PAF coversheet was submitted with no boxes checked in the Patient Status Exception section. Please send a valid progress note or check a patient status exception and resubmit the coversheet.
• No provider signature - No provider signature is on the progress note. At least one valid, signed progress note must be resubmitted.
• Invalid DOS - DOS presented does not align with the project year. A valid DOS must be submitted for the HQPAF/PAF to be processed. Submit a DOS that is the same year as the HQPAF/PAF project for which was submitted. Example: 2018 program year HQPAF/PAF needs to be accompanied by a 2018 DOS for eligibility.
• Signature log needed - The credentials are not present and/or identifiable on the progress note. Please submit a signature log. All providers using handwritten progress notes must assure that there is a signature log on file at Optum.

Your Healthcare Advocate, or the Provider Support Center, can provide you with a report to identify which of your HQPAFs/PAFs are in a rejected status. You can also refer to the Healthcare Quality Patient Assessment Form (HQPAF)/Patient Assessment Form (PAF) error code explanations document for additional reject reasons and solutions to resolve those issues.

Resubmit rejected HQPAFs/PAFs quickly and easily by using the PAF Uploader. The PAF Uploader allows users to securely submit HQPAFs/PAFs without issue of failed delivery or suspended access. The PAF Uploader also requires less time and effort than preparing and submitting documentation via mail or fax. The HQPAF/PAF Uploader:

• Does not require user credentials
• Complies with HIPAA requirements to protect your patient’s protected health information
• Allows anyone in your office to access the site and upload documentation
• Securely transmits directly to Optum

To get started, please visit: optumupload.com. Refer to the Healthcare Quality Patient Assessment Form (HQPAF)/Patient Assessment Form (PAF) Uploader document for additional instructions for submitting HQPAFs/PAFs via the PAF uploader.

Close Gaps via a Secondary Submission

For Comprehensive Gap Assessment Program (CGAP) providers, it is a great time of year to determine if there are any patients with suspect conditions that have yet to be assessed, evaluated or treated. If you have already submitted a HQPAF/PAF but need to submit additional data to support suspect and gap closure and improve CGAP performance, you may utilize a secondary submission.

A secondary submission can be utilized when:

• "Yes" was checked for a suspect, but no medical record documentation was submitted to verify that condition during the initial assessment
• "No" was checked for a suspect during the initial submission, but the suspect now exists and is documented in the medical record
• "Not Assessed" was checked for a suspect during the initial submission that is now assessed and documented
• One or more check boxes were left blank during the initial submission

Using the original HQPAF/PAF coversheet, update the applicable coversheet responses and submit the coversheet with a progress note containing a new DOS. If a new DOS is not included with the coversheet, the submission will be classified as a “duplicate” and therefore ineligible for CGAP. Secondary submissions can be submitted any time after the initial submission. Secondary Submissions are not eligible for the base reimbursement; however they are factored into the Gap Assessment Threshold and Documentation Verification components of CGAP.

If you have any questions on secondary submissions, 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.

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.