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 for members who live in Michigan. This year, Blue Cross HEDIS clinical consultants will conduct HEDIS reviews for members with Blue Cross’ PPO plans (including commercial, Medicare Plus Blue^SM and individual products) who had services in 2019.

Effective Jan. 1, 2020, to support HEDIS and government-required programs, the Blue Cross and Blue Shield Association has mandated who can retrieve medical records for patients living in Michigan but enrolled in another state’s Blue plan. Blue Cross Blue Shield of Michigan is authorized to retrieve medical records for patients enrolled in a Blue Medicare Advantage PPO plan in another state.

Inovalon, an independent data and analytics firm, is authorized to retrieve medical records for patients enrolled in all Blue Cross PPO plans, as well as Blue Medicare Advantage PFFS and HMO plans.

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 reporting 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.

If you have questions or concerns, contact Laurie Latvis at llatvis@bcbsm.com.

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