This article is for all providers, except behavioral health providers and dentists.
As required by the National Committee for Quality Assurance (NCQA), we will start to collect medical record information for the Healthcare Effectiveness Data and Information Set (HEDIS) audit in February 2022. Submitting your medical records promptly to us is important. Please respond to record requests within three weeks to ensure all necessary documents are submitted.
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 a reminder, complying with medical record requests from Blue Cross to support medical management, quality management, compliance, and other programs is a part of your provider Agreement with us. If you use a vendor for your medical records, be sure they know that they cannot bill us for the records.
We partner with a number of provider organizations and hospitals to receive direct electronic medical records (EMR) access, which allows us to extract only the required information we need. This method eliminates the need for your office staff to pull medical records and send them to us, saving resources for your individual practices. For more information on setting up remote EMR access, please contact Ankita Desai at 1-617-246-6577.
If remote submission is not an option for your organization, secure email, or fax is available. We can also set up a secure file transmission process (eSFTP) for larger volumes of records. For smaller volumes, please use our secure email or fax line, as the most efficient way to return records to us.
If you work with a third-party vendor to share medical records, please instruct them to return the charts by
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule has national standards to protect patients’ personal health information. Per HIPPA requirements, please send only the minimum amount of protected health information needed to meet this request.
If you have any questions or would like to discuss which medical record collection option is best for your practice, please call our Blue Cross HEDIS Team at 1-888-994-3347.
We appreciate your partnership and thank you in advance for responding promptly to this request.