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| Healthcare Quality Patient Assessment Form (HQPAF) and Patient Assessment Form (PAF) |
CGAP Documentation Verification & Keys to Success
Documentation Verification is an integral component of the Comprehensive Gap Assessment Program (CGAP). “Documentation Verification” is the verification that all diagnosed conditions, if any, are documented to the highest degree of specificity in the medical record submitted with the Healthcare Quality Patient Assessment Form (HQPAF)/Patient Assessment Form (PAF) and/or coded on claims from other encounters throughout the calendar year. Please note that verification via claims may be excluded for certain clients.
The CGAP Spotlight report permits tracking and confirmation of the Documentation Verification status for each condition populated on an HQPAF. Using the “Gap Status” column, you can confirm both the HQPAF/PAF cover sheet response that was captured as well as the status of verification for all diagnosed conditions. Note: At times, it may take up to 45 business days from the HQPAF/PAF return date for the Gap Status field to update. During the verification process, the Gap Status will be displayed as “Assessed and Unverified”. Once updated within the CGAP report, the results will be displayed as follows:
- Assessed and Verified – Condition was diagnosed (selected “Yes” in the Ongoing Assessment & Evaluation (OA&E) section) and has been documented to the highest degree of specificity in the progress notes or coded on a claim for an alternate date of service. To be considered for CGAP reimbursement, all conditions which the provider indicated were diagnosed (selected “Yes” in the OA&E section) must have a status of “Assessed and Verified”. No further action is required.
- Assessed – Condition has been addressed by the provider (selected “No” or “Referred” in the OA&E section) and was determined to be not present or the member has been referred to a different physician. No further action is required.
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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:
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Traceable carrier (any commercial carrier with traceable delivery) to the following address: |
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Optum – Prospective Programs Processing
15458 North 28th Avenue, Suite G
Phoenix, AZ 85053 |
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PAF Uploader: please visit optumupload.com |
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Secure Fax:
1‑877‑889‑5747 |
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- Assessed and Unverified – Condition has been addressed by the provider (selected “Yes” in the OA&E section), however the proper documentation was not submitted or that which was submitted does not meet CMS guidelines. A secondary submission, with a new date of service, is required to close the gap in care.
- Not Assessed – Condition was not addressed (provider selected “Not Assessed” in the OA&E section) or left blank. A secondary submission, accompanied by an updated HQPAF cover sheet, along with a new date of service, is required to close the gap in care..
If you need additional assistance on navigating the Spotlight report, please sign up for the upcoming provider training session on August 7. Additionally, you can view the CGAP FAQ for Providers to get answers on frequently asked CGAP questions.
Provider Training Opportunities
To ensure successful participation in the HQPAF/PAF program, Optum offers trainings on a variety of different topics, including an introduction to Medicare Advantage Risk Adjustment, Clinical Documentation Improvement and disease-specific courses. We encourage you to take advantage of these training opportunities! Please reach out to your Healthcare Advocate with questions about these trainings or other coding and documentation tools that are available through Optum. For more information on these training opportunities, click here to view the Optum 2018 WebEx coding calendar, and follow the registration instructions to sign up.
Why am I receiving new HQPAFs/PAFs?
Throughout the year, we receive updated information about your patient population. For example, members may move from one health plan to another. Additionally, we see new care opportunities arise for the current patient population. When these events happen, new HQPAFs/PAFs are created to assist providers in offering comprehensive care to their patients.
If you use the Optum Patient Assessment Form (OPAF) portal, the new HQPAFs/PAFs will automatically appear in your Inbox as the system is refreshed each month. If you currently have your forms delivered via paper or CD, your Healthcare Advocate will now begin ordering these forms to be sent to you. So, be on the lookout.
The same administrative policies apply to these new HQPAFs/PAFs as they did for your initial deployment. Please continue to submit completed forms with progress notes that meet state or federal documentation and coding standards. Remember to ask your Healthcare Advocate about any rejected HQPAFs/PAFs that you can remedy and resubmit.
If you have questions about when you will be receiving your additional forms, please reach out to your Healthcare Advocate or contact the Provider Support Center at 877-751-9207.
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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.
© 2018 Optum, Inc. All rights reserved. |
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