Many of our providers have already received letters from our Quality Management department as part of our annual medical record review. This review is required for Healthcare Effectiveness Data and Information Set (HEDIS) reporting, Regulatory State reporting, and by the Centers for Medicare & Medicaid Services (CMS).
Compliance with HEDIS data collection is part of your Participating Provider Agreement(s). HEDIS and CMS consider missing records as noncompliant. Therefore, if you receive these letters — which contain a list of patients for whom we need medical records and a HEDIS Medical Record tip sheet — 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.
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 64940 03/2024