Health e-Blue update: New requirement to submit quality data for HEDIS measures

As part of our ongoing efforts to align with updated federal and accreditation standards, Blue Cross Blue Shield of Michigan and Blue Care Network are announcing important changes about quality data submissions.

Effective Jan. 1, 2026, quality data submitted through Health e-Blue℠ for incentive or contract performance must include primary source verification in the form of a medical record for these HEDIS^® measures:

• Breast cancer screening
• Colorectal cancer screening
• Diabetes care — eye exam

In addition, beginning in 2026, Health e-Blue entries for all measures must be completed by Dec. 31 of the measurement year. We’ll no longer accept entries into the following year.

Starting on Jan. 1, 2027, Blue Cross and BCN will no longer accept Health e-Blue entries for any measure without primary source verification in the form of a medical record.

Later this year, we’ll share more details about this important change, including how to submit the medical record.

This change is in direct response to the Centers for Medicare & Medicaid Services and the National Committee for Quality Assurance making significant updates to their quality measurement frameworks. CMS and NCQA are placing increased emphasis on the use of standardized data to ensure consistency, accuracy and comparability across health care organizations.

Failure to comply will result in the removal of a closed gap in Health e-Blue, incentives and contracts.

Action steps

To ensure a smooth transition and compliance with these changes:

• Prioritize sending measures electronically or through claims.
• Prepare to submit medical records for primary source verification in 2026. Make sure documentation for services related to quality measures is complete and accurate in each patient’s medical record.
• Prepare for electronic medical record Physician Payer Quality Collaborative and Quality Measure Improvement audits for quality measures.
• Retire manual entry workflows, as applicable.

We recognize these changes may present challenges, and we’re committed to supporting you through this transition. We’ll provide additional information about this important change in future 2025 editions of The Record.

In the meantime, if you have questions or concerns about these new requirements, contact your physician organization or medical care group administrator. They can reach out as needed to their Blue Cross quality improvement performance consultant.

Thank you for your partnership and for your continued commitment to delivering high-quality care to our members.

HEDIS is also known as the Healthcare Effectiveness Data and Information Set. HEDIS^® is a registered trademark of the National Committee for Quality Assurance.