FLASH: HEDIS Chart Reviews for 2021 Coming Soon

Each spring, we collect data to determine how we measure up against national averages for HEDIS^® (the Healthcare Effectiveness Data and Information Set). This data collection and analysis is required for National Committee for Quality Assurance (NCQA) accreditation, and it indicates where we need to focus our quality efforts to better serve our members and provider partners.

To successfully gather our data and generate our HEDIS report, we rely heavily on the cooperation we receive from providers’ office staff. For most provider offices and organizations, we now have remote access to the Electronic Medical Record. This allows us to conduct reviews without disrupting the provider offices’ staff or processes. For the offices where we do not yet have remote electronic access, we’d typically have our representatives visit in-person in the spring. They’d ask to review specific medical records or ask you to copy, fax or mail records to us as part of the audit. Due to the ongoing COVID-19 pandemic and the importance of restricting in-person meetings, our HEDIS Team may ask to connect with your office staff via Skype, Microsoft Teams or over the phone, with specific records mailed or faxed following the review. All individually identifiable information concerning patients will be kept strictly confidential in compliance with HIPAA regulations.

Results of the HEDIS audit will be available on our website in fall 2021. If you have any questions about HEDIS, contact the Quality Management Department at (800) 851-3379, ext. 28288 or 29354.

To learn more about Electronic Medical Records (EMR) or to implement our shared access to your office’s records, view the information in this flier

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

2021 – Updates

• The COVID-19 pandemic brought many challenges in 2020. NCQA and the Centers for Medicare and Medicaid Services (CMS) made adjustments for health plans collecting medical record data through medical record review. Even though the pandemic continues, no further adjustments are expected from either NCQA or CMS.
• Changes for HEDIS 2021 Reporting Year, measurement year 2020:
  • Telehealth visits are included as compliant for most hybrid measures.
  • Patient reported values are acceptable for blood pressures as long as the blood pressure was taken with automated equipment and was not taken manually.

If you have questions, contact your provider relations specialist.

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