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February 2024
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Feature Stories
Annual HEDIS Medical Record Review: Responses Due March 29, 2024
Our Quality Management department is preparing 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. Please 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.
We recently added a new chat feature to our provider portal. Now you can message with a Provider Customer Service Representative in real time while you are using the portal. Watch this video to learn more: Watch video
Reminder: Fax Lines To Be Disconnected May 2024
Starting May 1, 2024, we will disconnect the fax lines for preauthorization requests and concurrent reviews. Please start using the provider portal to submit your requests and supporting documentation. See the full announcements for more information (EmblemHealth | ConnectiCare).
National Kidney Month is the perfect opportunity to teach patients about the importance of screening to help prevent kidney disease. It’s especially important for patients with chronic conditions such as diabetes and high blood pressure who are at high risk for developing kidney disease.
Ways to help your patients:
- Teach patients about the importance of diet, exercise, nutrition, weight control, and sleep.
- Create a treatment plan for at-risk patients that fits their lifestyle and dietary needs.
- Order a kidney health evaluation annually for all patients with Type 1 or Type 2 diabetes. This evaluation should include:
- Estimated glomerular filtration rate (eGFR).
- Urine albumin-creatinine ratio (uACR).
Here are some resources you can share with your patients:
In recognition of Colorectal Cancer Awareness Month, we hope you will take this opportunity to teach patients about the importance of colorectal cancer screening, prevention, and treatment. Colorectal cancer screening should begin at age 45 for those with average risk.
The following resources can help you educate patients:
- Colorectal Cancer Screening: Patient Version (National Institute of Health).
- Colorectal Cancer Screenings Tests (CDC).
- Colorectal Cancer Screening Patient Poster (American Society for Gastrointestinal Endoscopy).
- Resources for National Colorectal Cancer Awareness (American Society for Gastrointestinal Endoscopy).
MD Perspectives
Hello, colleagues,
In observance of National Drug and Alcohol Facts Week (March 18 – 24, 2024), I have information you can share with your patients regarding opioid overdose and the opioid antagonist, naloxone.
See my full blog in Mental Health Matters and the resources we published on opioid overdose medication.
Kelly
Kelly McGuire, MD, MPA
Medical Director, Psychiatry
If there are other health topics you would like our perspectives on, please write to us at emblemhealthmedicaldirectors@emblemhealth.com. The mailbox should not be used for patient-specific issues, claims inquiries, complaints, grievances, appeals, etc. and should not include protected health information (PHI). Instead, use the Claim Inquiry and Message Center features of the provider portals (EmblemHealth | ConnectiCare) for those purposes.
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