HEDIS medical record reviews begin in February

Each year from February through May, Blue Cross Blue Shield of Michigan and Blue Care Network conduct 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 services rendered in 2021 for members with:

• Blue Cross commercial
• BCN commercial
• Medicare Plus Blue℠
• BCN Advantage℠
• Individual products

As part of its efforts to support HEDIS and government-required programs, the Blue Cross and Blue Shield Association mandates which entities can retrieve medical records for patients living in Michigan but enrolled in another state’s Blue plan. Blue Cross is authorized to retrieve medical records for patients enrolled in a Blue Medicare Advantage plan in another state.

Inovalon, an independent data and analytics firm, is authorized to retrieve medical records for patients enrolled in Blue Cross commercial and BCN commercial plans, as well as Blue Medicare Advantage private fee-for-service 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 and colorectal cancer screenings. This information helps us improve health care quality reporting for our members.

Blue Cross’ HEDIS clinical consultants will contact health care providers to schedule an appointment for a HEDIS review or request that providers 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 Ellen Kraft at ekraft@bcbsm.com.

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