Health Status Inquiry Report

As a Medicare Advantage plan, Martin’s Point Generations Advantage is required to collect information relating to the health status of our members and to provide this information to CMS. If a previously documented chronic or long-term condition is not restated by the provider in the most recent calendar year, the Health Status Inquiry Report (HSIR) affords the provider another opportunity to confirm the presence of the condition in question. As directed by CMS, we also ask for the documentation related to the visit in which the provider assessed the condition during that year.

Why is this work Important?

  1. To promote the health of our members/your patients: As a health plan, we use claims information to help us identify the disease burden of your patients. This information plays a critical role in identifying members/patients who could benefit from additional care management resources.  By partnering with providers to confirm these chronic conditions via the HSIR process, we can deploy the appropriate resources to help keep your patients healthy.

  2. To comply with CMS Medicare Advantage program requirements to validate applicable diagnosis data each year: Generations Advantage and our network providers share responsibility for the documentation we are required to submit to CMS regarding the health status of our members. Our goal is to document existing diagnoses and identify diagnoses that were reported in error—accurately capturing the current health status of our members.

How does this work?

We typically send out HSIR forms in two batches —in September and October/November. If our records indicate that a previously recorded condition may not have been restated in the most recent year, you may receive an HSIR form for each affected qualifying Generations Advantage member.

The HSIR reports:

  • List each patient’s previously reported chronic conditions to be restated
  • Ask for verification of the continued existence of each of those conditions
  • Ask for documentation of the provider's assessment of the noted condition
To earn incentive payments:
  1. Complete the HSIR form on or before January 15 for the previous year.

  2. Along with the completed form, please send in a copy of the completed encounter note that provides supporting documentation (including assessment and plan) for the diagnosis in question

  3. Please send this information via mail, fax, or secure email.
    Mail: Martin’s Point Health Care
    ATTN: Clinical Documentation
    PO Box 9746
    Portland, ME 04104
    Phone: (207) 771-2660 Fax: (207) 828-7840
    SECURE Email: [email protected] (Please put “HSIR” in subject of email and use a secure, encrypted email application to send.  If you do not have access to a secure email application, please send by mail or fax.)

For information about this program
Call: (207) 253-6147