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Changes to Provider Attestation Form Submission

Adequate and proper medical documentation is essential for quality medical care. Yearly, we conduct audits to review practitioner documentation and ensure compliance with Centers for Medicare & Medicaid Services (CMS) and New York State Department of Health (NYSDOH) regulatory requirements and to meet National Committee for Quality Assurance (NCQA) standards of patient care.

To alleviate the medical chart requests, throughout the calendar year EmblemHealth’s Quality Management team will ask that you attest to care provided to our members, considered by NCQA as nonstandard supplemental data. In the past, the process was to use signed and dated provider attestation forms that were faxed to the Quality Management team. This form alone without additional proof of delivery of the service was sufficient.

Now, NCQA has implemented new policy changes starting with 2013 reporting. Nonstandard supplemental data must be substantiated by proof of delivery of the service from the legal health record for every case recorded. EmblemHealth as an organization using nonstandard supplemental data, in every case, must collect copies of the proof-of-service documents. The following are examples of allowable Proof-of-Service Documents:

  • Copy of the patient's chart from the service provider
  • Copy of the clinical report or clinical summary from the visit for service
  • Online EHR or immunization registry screen shots

As a result, provider attestation forms must now be accompanied by a copy of the member’s legal health record. For more information, NCQA recently gave a presentation on this topic.


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