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February 2018
HEDIS medical record reviews begin in February
Each year, from February through May, Blue Cross Blue Shield of Michigan conducts Healthcare Effectiveness Data and Information Set, or HEDIS®,** medical record reviews. This year, Inovalon™ will conduct HEDIS reviews for Blue Cross commercial PPO, Medicare Plus Blue℠ PPO and Blue Cross® Medicare Private Fee for Service members for the 2017 measurement year.
For the HEDIS reviews, Inovalon looks for details that may not have been captured in claims data, such as blood pressure readings, HbA1c lab results, colorectal screenings and body mass index. This information helps us improve our member quality initiatives.
Inovalon will contact you to schedule an appointment for a HEDIS review or request that you fax the necessary records. The HEDIS review also requires proof of service documentation for data collected from a medical record.
These reviews are in addition to the out-of-state medical record reviews that Inovalon conducts for the Blue Cross Blue Shield Association.
To give you a look ahead at all 2018 chart reviews, see the table below.
Review |
Dates |
Vendor |
Medicare Advantage RADV |
January – June 2018 |
In Michigan – Tessellate;
outside Michigan - Inovalon |
Commercial retro |
January – March 2018 |
Verscend |
HEDIS |
February – May 2018 |
Inovalon; Blue Cross Blue Shield of Michigan |
Medicare Advantage retro |
February – December 2018 |
CIOX |
Commercial RADV |
June – November 2018 |
In Michigan – Tessellate;
outside Michigan - Inovalon |
Stars |
September – December 2018 |
Blue Cross Blue Shield of Michigan; Tessellate |
**HEDIS® is a registered trademark of the National Committee for Quality Assurance.
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