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 2024 for members with:

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

You may receive a letter requesting medical records as part of this process.

More information about our HEDIS reviews

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.

Virtix Health, 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, lab services, diabetic eye exam screenings and admission and discharge documentation. 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.

Completing medical record requests if you receive a letter

The preferred and most efficient way to complete these reviews is through remote EMR access. For details, email Ellen Kraft, RN, director of Quality and Provider Education, at ekraft@bcbsm.com. You can also fax or send records through secure email. If your office works with a copy house vendor, all records must be submitted timely. Your office is obligated to submit any outstanding records.
 
If Datavant is your copy vendor, include the following when forwarding it our record requests: Datavant BCBSM Account Number: 2212751.

For practices and groups that have an internal dedicated team completing medical record requests, please send an email to the individuals below including the office specifics and group contact information. Blue Cross will work to see that all requests for practices affected are sent directly to your internal dedicated teams throughout this project season.  

• Jennifer Hartman: jhartman@bcbsm.com
• Rebecca White: rwhite4@bcbsm.com

If you have questions or concerns, here’s who to contact:

• If you have questions about HEDIS medical record reviews, email Ellen Kraft, director, Quality and Provider Education, at ekraft@bcbsm.com.
• Our Corporate and Financial Investigations Unit is aware of provider offices receiving fraudulent requests for patient information, provider NPI numbers and provider signatures. If you receive a suspicious request, contact our Fraud Hotline at 1-844-STOP-FWA (1-844-786-7392) or send an email to StopFraud@bcbsm.com. We may ask you to share the request so we can check its legitimacy.

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