Our Quality Management department is preparing for its yearly medical record review for the Healthcare Effectiveness Data and Information Set (HEDIS®), Regulatory State Reporting, and the Centers for Medicare & Medicaid Services (CMS). In the next couple of weeks, you may receive a letter containing a list of your patients for whom we need medical records and a HEDIS Medical Record tip sheet. We ask that you send us back the patient list and the section of the patient chart that shows the HEDIS measure has been met. The return fax number and secure email instructions will be noted in the letter.
This project involves collecting information from medical records and submitting the findings to the state and the National Committee for Quality Assurance (NCQA). Compliance with HEDIS data collection is part of your Participating Provider Agreement(s). HEDIS and CMS consider missing records as noncompliant.
NOTE: If you use outside vendors to collect medical records, it is your contractual obligation to make members’ medical records available to the plan – at no charge – for these reviews.
We appreciate your cooperation and thank you in advance for your prompt response. If you have any questions or concerns, call our HEDIS Helpline at 631-844-2420.
JP 61384 02/2023