|
February 2013
HEDIS medical record reviews begin in February
Each year, Blue Cross Blue Shield of Michigan conducts Healthcare Effectiveness Data and Information Set medical record reviews. Inovalon™ will perform the HEDIS reviews from February through May on behalf of PPO and Medicare Advantage PPO members beginning this month.
These reviews don’t replace the risk adjustment medical record review process also performed by Inovalon on behalf of BCBSM’s Medicare Advantage PPO.
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, cholesterol and colorectal screenings, and body mass index. This information helps us enhance our member quality improvement initiatives.
Inovalon will contact you to either schedule an appointment for a HEDIS review or request that you fax the necessary records. BCBSM will reimburse you $5 for each requested medical chart.
The chart below outlines the reviews and when they will be performed:
Review |
Reviews scheduled |
HEDIS |
February through May 2013 |
Medicare Advantage Risk Adjustment Review Process 1
(FRO 1) |
January through March 2013 |
Medicare Advantage Risk Adjustment Review Process 2 (RRO) |
April through May 2013 and October 2013 through
January 2014 |
Medicare Advantage Risk Adjustment Review Process 3
(FRO 2) |
June through September 2013 |
If you have any questions, please contact your provider consultant.
| 