Loading...Loading...Reminder: Beginning September 1, 2025, all clinical records necessary to complete medical necessity reviews must be available by EMR or submitted by fax within 24 hours of acute inpatient hospital medical admissions. This timeframe coincides with our 24-hour inpatient admission notification requirements and applies to admissions for all lines of business.
We will no longer provide clinical records deadlines when we fax acknowledgment of admissions notification.
- If you use PointClickCare (PCC) and grant electronic medical record (EMR) access, you will not experience a change in process. Ensure records are viewable in your EMR within 24 hours of admission.
- If you don’t grant EMR access, fax complete clinical records within 24 hours of admission. The face sheet and/or admission diagnosis alone are not sufficient. Contact your provider relations executive to learn more about connecting your EMR.
If a facility does not submit clinical records within 24 hours of admission, the admission may be administratively denied as provider liability.
View our authorization and records requirements on our pre-authorization lists.
8/5/2025
When responding to medical records requests from CERIS, you can now upload records to the CERIS portal.
To register for the portal, you will need an active records request from CERIS. During registration, you'll be prompted to enter a Case ID, which can be found on your records request letter from CERIS. The Case ID begins with an alpha character and verifies your association with the Tax Identification Number (TIN).
CERIS reviews diagnosis-related group (DRG) claims on our behalf.
7/16/2025
CMS is warning Medicare providers about a rise in phishing scams involving fraudulent fax requests for medical records. These schemes involve bad actors impersonating CMS and falsely claiming the requests are related to a Medicare audit. CMS does not initiate audits via fax.
Unlike traditional email phishing, these scams use fax machines to appear more legitimate and catch practices off guard. They may appear to use CMS or National Archives and Records Administration (NARA) letterhead and may demand information in a short timeframe (e.g., 72 hours).
Legitimate medical record requests by CMS, or their contractors, will identify specific Medicare beneficiaries, time periods and encounters or prescription drug event records involved. They will also allow ample time (typically 30-45 days) for response. CMS urges providers and staff to remain vigilant.
Phishing is a form of social engineering that attempts to deceive recipients into disclosing sensitive information. While email attacks remain common, fax-based scams are a growing threat, especially when they mimic official-looking audit requests.
What to do:
- Do not respond to any suspicious fax requests for records.
- Verify the legitimacy of any audit or documentation request through Noridian.
- Report suspected fraud or phishing attempts to CMS.
7/8/2025
Provider search on our authenticated member website and Regence app now features provider performance ratings to help members identify high-performing, high-value, in-network providers. Ratings are based on objective, third-party data and analytics, as well as health plan claims data, and evaluate physicians based on a comprehensive evaluation of evidence-based medicine (quality and appropriateness of care) and cost efficiency.
- For members, higher-rated providers appear at the top of search results, although results can still be sorted according to their preference, such as by distance or name.
- For physicians, these ratings showcase your commitment to quality and value, helping connect you to patients who will benefit most from your expertise.
Provider Performance Scorecards
Physicians can access personalized Provider Performance Scorecards that include:
- Their overall rating level
- Detailed breakdowns of performance in each evaluation category
- Comparison to peer benchmarks
- Specific metrics that influence ratings
- Suggestions for improvement in performance
To view your scorecard, sign into Availity Essentials: Payer Spaces>Provider Reports>Credentialing & Maintenance Reports>Provider Performance Report.
Learn more
Sign into Availity Essentials: Regence Payer Spaces>Resources>Provider Performance Ratings to view:
- A comprehensive guide to provider performance ratings
- An overview of Provider Performance Scorecards
- Answers to frequently asked questions
- Detailed information about the reconsideration process
- Performance measure guides
Read more about provider performance ratings in the May special edition and June issues of our newsletter.
6/30/2025
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