Note: This requirement does not apply to behavioral health medical records.
As required by the National Committee for Quality Assurance (NCQA), Blue Cross will start to collect medical record information for the 2019 Healthcare Effectiveness Data and Information Set (HEDIS) (measurement year 2018) audit in February. HEDIS is one of the ways we measure the quality of care you provide to our members and is a very important activity for all NCQA-accredited health plans.
Your help in submitting your medical records promptly to us is important. These reviews ensure that we remain compliant with state and federal regulations related to accurate medical coding and documentation, help us learn about our members’ care, and to identify opportunities for improvement.
As part of your provider Agreement, you must comply with all medical record requests from Blue Cross to support medical management, quality management, compliance, and other programs. Here’s what to expect from us:
|Request type||Mailed to your office||Submission options|
|Healthcare Effectiveness Data and Information Set (HEDIS)||Starting February 2019||
* We recommend remote submission to ease your office’s administrative burden, and to make this as easy as possible.
Not all submission options are available for every request. Please contact us to discuss the best options available for your group.
If you have any questions about HEDIS or the medical record collection process, please call 1-888-994-3347. Thank you in advance for responding promptly to this request.