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Care Report

Care Opportunity Reports

Dear Provider,

Below you have access to your current Care Opportunity Report. The Care Opportunity Report is a tool you can use to identify your patients’ gaps in care. The report is generated from claims data, therefore, services rendered within the last 30-90 days may not be included nor will services rendered prior to your patient enrolling with AvMed.

Having proper coding practices is the best way to close member gaps in your Care Opportunity Report and reduces the need for medical record reviews. Please refer to our HEDIS Matrix for specific codes by measure. Pediatric providers: click here to view the Pediatric and Adolescent HEDIS Matrix.

If you have information regarding a member that you are unable to submit via a claim, you can close a gap by submitting the medical records indicating the member has already received the relevant service or has a condition that excludes them from the measure. All medical records should include the member’s name, date of birth and date of service. Please fax all medical records, along with a completed Care Opportunity Report Provider Response Form, to AvMed Corporate Quality Improvement Department at 1-800-331-3843.

For questions, please contact your AvMed physician liaison or the Provider Service Center at 1-800-452-8633. A Medical Director may be contacting you to discuss the results in this report.