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February 2017

HEDIS® reviews begin in February

Each year, from February through May, Blue Cross Blue Shield of Michigan conducts Healthcare Effectiveness Data and Information Set medical record reviews. This year, Inovalon™ will conduct these HEDIS** reviews for Blue Cross PPO and Medicare Plus BlueSM PPO members who received services in Michigan during 2016.

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. HEDIS also needs proof of service documentation for data collected from a medical record. Blue Cross will reimburse you $5 for each chart Inovalon receives.

These reviews are in addition to the out-of-state medical-record review process performed by Verscend® for the Blue Cross and Blue Shield Association.

**HEDIS is a registered trademark of the National Committee 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 2016 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.