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Optum
Patient Assessment Form (PAF) and Healthcare Quality Patient Assessment Form (HQPAF)
Successfully Closeout the 2017 HQPAF/PAF Program Year

It’s already November which means we have officially arrived at the last quarter of the year. This is a great opportunity to reach out to your patients and encourage them to schedule those last minute, end of the year appointments. It is also a great time to stop and reflect on those members and determine if there are any chronic conditions or suspect conditions that have yet to be assessed, evaluated or treated. This is also a great time to encourage those patients who have not been seen to get their Annual Wellness Exam scheduled with their Primary Care Physician. It is vital that we end the year by ensuring that this patient population has been seen and any chronic condition previously reported has been evaluated and assessed in this calendar year.

If you are unable to perform the annual comprehensive exam for a member for whom you received an HQPAF/PAF, complete the Patient Status Exception section of the form and return it to Optum. You may submit only the page containing the Patient Status Exception section.

Should you have questions about your patient population or need assistance with identifying their chronic conditions, please reach out to your Healthcare Advocate for assistance. They can help you prioritize your population and assist with identifying those important chronic conditions still needing evaluation and assessment.

Additionally, there is still time to resolve your submitted rejected 2017 HQPAFs/PAFs. When an HQPAF/PAF submission does not comply with the program’s guidelines, a Rejection code is applied. Rejected forms cannot be processed and administrative reimbursement (if applicable) cannot be issued. Nationally, 44% of rejected HQPAFs/PAFs remain in a rejected status. This equates to roughly 26,000 HQPAFs/PAFs. Most rejections can be easily resolved to permit processing. The top reasons for HQPAF/PAF rejections are:
Did you know …

 Your Optum Healthcare Advocate or the Provider Support Center can provide access to a number of tools to assist you in tracking your participation in the program. Please contact your Healthcare Advocate or Optum’s Provider Support Center at 877‑751‑9207 or via email at providersupport@optum.com with any questions.

To minimize errors, or to correct previously rejected forms, please refer to the HQPAF Checklist and FAQ for Providers.

Remember …

PAF/HQPAF must be
submitted via:

• Traceable carrier (any commercial carrier with traceable delivery) to the following address:
Optum – Prospective Programs Processing
15458 North 28th Avenue, Suite G
Phoenix, AZ 85053
• PAF Uploader: please visit optumupload.com
• Secure Fax:
1‑877‑889‑5747
  • Coversheet only - Only HQPAF/PAF was submitted with no “change in patient status” boxes checked. Provider must send valid progress note or check a patient status exception.
  • No Provider Signature - No provider signature is on the progress note. Valid, signed progress note must be resubmitted.
  • Invalid DOS - DOS presented does not align with the project year. A valid DOS must be submitted for HQPAF/PAF to be processed. Provider needs to submit a DOS that is the same year as the PAF project it is submitted for. Example: PAF _2017 needs to be accompanied by a 2017 DOS for eligibility.
  • Signature Log Needed - The credentials are not present and/or identifiable on the progress note. Provider must submit a signature log. All providers using handwritten Progress notes must ensure that there is a signature log on file at Optum.
Your Healthcare Advocate can provide you with a report to identify which of your HQPAFs/PAFs are in a rejected status. You can refer to the Healthcare Quality Patient Assessment Form (HQPAF)/Patient Assessment Form (PAF) error code explanations document for additional reject reasons and solutions to resolve.

Resubmit rejected HQPAFs/PAFs easily and quickly by using the HQPAF/PAF Uploader. The HQPAF/PAF Uploader was developed to provide an interface that allows multiple users to securely submit HQPAFs/PAFs without issue of failed delivery or suspended access. The HQPAF/PAF Uploader:
  • does not require any user credentials
  • complies with all HIPAA guidelines to protect your practice and your patient’s personal data
  • allows anyone in your office to access the site and upload documentation
  • securely transmits directly to Optum
The HQPAF Uploader requires less time and effort than preparing and submitting documentation via mail or fax. To get started, please visit: optumupload.com. Refer to the Healthcare Quality Patient Assessment Form (HQPAF)/Patient Assessment Form (PAF) Uploader document for additional instructions for submitting HQPAFs/PAFs via the HQPAF/PAF uploader.

Thank you for your cooperation and participation!
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 (excluding weekends and holidays), 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.

We no longer offer SFTP as an option to submit your Healthcare Quality Patient Assessment Forms/ Patient Assessment Forms (HQPAF/PAF). We encourage you to use our new HQPAF/PAF Uploader; an easier and faster submission method. The HQPAF/PAF Uploader requires less time and effort than preparing and submitting documentation via mail or fax.

The HQPAF/PAF Uploader was developed to provide an interface that allows multiple users to securely submit HQPAFs/PAFs without issue of failed delivery or suspended access. The HQPAF/PAF Uploader:
  • Does not require any user credentials
  • Complies with all HIPAA guidelines to protect your practice and your patient’s personal data
  • Allows anyone in your office to access the site and upload documentation
  • Securely transmits directly to Optum
To get started, please visit: optumupload.com.

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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