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Inovalon-Horizon Update

As we have previously reported to you, Inovalon is a company that is collecting patient records to perform risk adjustment reviews on behalf of Horizon.  Risk adjustment reviews are reports required by and provided to the government as dictated by the Patient Protection and Affordable Care Act (PPACA aka Obamacare).  All carriers collect data for these reports and in the years these have been required we have not yet seen a negative consequence for any provider stemming from these record collections.

Beginning late 2019 and continuing now in early 2020, we have heard from many members that they are being asked for in some cases a large number of patient files.  The volume of providers being asked and the number of patients requested of each provider have seemed higher than what is normally seen for these reviews.  There has been speculation that the requests may be for some purpose beyond the stated risk adjustment reviews. 

I have reached out to Horizon and inquired as to why the volume of requests is so high for these reviews and if the records are being used for any other purpose.  Horizon has responded that any and all record requests from Inovalon are strictly for risk adjustment reviews and no other purpose. 

Further, they advise that they began their partnership with Inovalon late in the year of 2019 and hence need to essentially catch up on records gathered leading to the condensed higher volume of record requests.  They advise that this should not continue to be the practice of the program going forward.