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 these reviews for services rendered in 2023 for members with:

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

In support of HEDIS and other government 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 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. HEDIS reviews also require proof of service documentation for data collected from a medical record. The preferred and most efficient way to complete these reviews is through remote EMR access. For details, email Jennifer Hartman, manager, Quality and Provider Education, at jhartman@bcbsm.com.

You can also fax or send records through secured email. If your office works with a copy house vendor, all records must be submitted in a timely manner. Your office is obligated to submit any outstanding records.
 
If Ciox is your copy vendor, include the following when forwarding them our record requests: Ciox BCBSM Account Number: 2212751.

If you have questions or concerns, email Ellen Kraft, director, Quality and Provider Education, at ekraft@bcbsm.com.

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