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February 2014

HEDIS® medical record reviews begin in March

Blue Cross Blue Shield of Michigan conducts Healthcare Effectiveness Data and Information Set medical record reviews each year. Inovalon™ will perform the HEDIS reviews from March through May on behalf of PPO and Medicare Advantage PPO members who received services in Michigan.

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 schedule an appointment for a HEDIS review or request that you fax the necessary records. HEDIS requires proof of service documentation for data collected from a medical record. BCBSM will reimburse you $5 for each chart requested and received.

Inovalon will continue to perform the risk adjustment medical record review on behalf of BCBSM’s Medicare Advantage PPO members who received services in Michigan. 

These reviews are conducted in addition to the risk adjustment and HEDIS medical record review process performed by Verisk on behalf of the Blue Cross and Blue Shield Association.

HEDIS® is a registered trademark of the National Commitee for Quality Assurance.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.