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Thank you for participating in the 2015 Patient Assessment Form (PAF) program and the Healthcare Quality Patient Assessment Form (HQPAF) program. We are here to assist you in any way that you need so please do not hesitate to contact your Optum Healthcare Advocate with any questions or concerns you may have.
Complete comprehensive assessments
The PAF and HQPAF programs promote early detection and ongoing assessment of chronic conditions for our clients’ Medicare Advantage, Managed Medicaid and Affordable Care Act (ACA) members. The goal of the PAF/HQPAF program is to help ensure that patients receive a complete and comprehensive annual assessment at least once per year as well as support a variety of quality programs, including the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System or "Star Ratings". To support these goals, the PAF/HQPAF should be used at the point of care to ensure all care opportunities are addressed.
Routine exams and screenings can help identify and detect chronic conditions, often before your high-risk Medicare Advantage, Managed Medicaid and ACA patients have any symptoms. In order to capture the most accurate depiction of the patient’s health status, all conditions, both acute and chronic, should be evaluated and documented annually in the patient chart and then coded to the highest level of specificity.
The PAF/HQPAF is designed to assist providers in determining a comprehensive treatment plan, including appropriate preventive and wellness care. Below you can find a brief description of the different sections of the PAF/HQPAF.
Early Detection and Managing Chronic Illness
These sections of the PAF/HQPAFs are a simple reminder to consider a screening based on previously coded risk factors. Please refer to our Early detection of chronic illness screening tool for PAF/HQPAF for screening the conditions you may find on your patient’s PAF/HQPAFs.
Preventive Medicine Screening
There may be screening(s) that are due or overdue, as indicated by HEDIS and health plan data. Our PAF/HQPAF will indicate screenings to consider for your members. Our HEDIS and Five-Star Quality documentation guidelines may help ensure you have included all the necessary documentation.
Ongoing Assessment & Evaluation
Prior and current diagnosed conditions that have been identified for your patient will be listed here. Some recommended conditions may have been diagnosed and treated by other providers. Please review all conditions carefully as you evaluate your patient. Remember to document all conditions evaluated, monitored and treated during the visit to the highest level of specificity.
Medical History Reported to the Health Plan
This section provides historical information about patients to the healthcare provider. This health information may include:
- PCP, specialists and hospitalization history
- Prescription history
- Information on previously diagnosed conditions
- Potential gaps in preventive screenings or recommended chronic illness treatment
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.
As of January 1, 2016, all providers that qualify for HQPAF/PAF administrative reimbursement must receive their reimbursement via direct deposit. In 2016, administrative reimbursement will be completely paperless and checks will no longer be available. To ensure that you do not experience delays in 2106 payments, please visit optum.com/hqpaf or contact Electronic Payments & Statements (EPS) directly at 1-877-620-6194 to enroll.
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.
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