The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used sets of heath care performance measures in the United States. 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.
As required by the National Committee for Quality Assurance (NCQA), we will start to collect medical record information for the 2020 HEDIS audit (claims measurement year 2019) in February.
Your help in promptly submitting your medical records for all BCBSMA requests is important and part of your contract. If you use a vendor for your medical records, be sure they know that they cannot bill us for the records.
We know that you may sometimes receive record requests from different parts of our organization. We try to streamline these requests, but it is not always possible due to different reporting requirements. Your provider agreement requires you to respond to all medical record requests you receive from us. These support our medical management, quality management, compliance, and other programs.
We recommend using remote access or onsite reviews to ease your office’s administrative burden. To set up onsite reviews or remote access, please contact Patty Donoghue at the number below.
|Request type||Mailed to your office||Submission options|
|HEDIS||Starting February 2020||
Please contact us to discuss the best options for your group.
|Medicare risk adjustment record requests||Spring|
|Commercial risk adjustment record requests||Fall|
If you have any questions about HEDIS, or to set up remote access or onsite review, please Patty Donoghue at 617-246-8838 or 1-888-994-3347. Thank you in advance for responding promptly to this request.