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February 2019

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, Blue Cross HEDIS clinical consultants will conduct HEDIS reviews for Blue Cross commercial PPO and Medicare Plus BlueSM PPO members for the 2018 measurement year.

For the HEDIS reviews, Blue Cross 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 health care quality for our members.

Blue Cross HEDIS clinical consultants 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 and Blue Shield Association.

To give you a look ahead at all 2019 chart reviews, see the table below.

Focus area

Dates

Company conducting review

Medicare Advantage RADV

January to June 2019
  • Advantasure
  • Inovalon

Commercial – retrospective

January to March 2019
  • CIOX

HEDIS

February to May 2019
  • Blue Cross Blue Shield of Michigan
  • Advantasure

Medicare Advantage – retrospective

February to December 2019
  • CIOX
  • Inovalon

Commercial risk adjustment data validation, or RADV

June to November 2019
  • Advantasure

Medicare star ratings

September to December 2019
  • Blue Cross Blue Shield of Michigan
  • Advantasure

To read more about medical record reviews, see article, “Here’s what you need to know about medical record reviews,” also in this issue.

**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 2018 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.