Publication Date: 

In the coming weeks, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will collect our members' medical records for the annual Healthcare Effectiveness Data and Information Set (HEDIS) reporting requirements. We appreciate your commitment to providing high-quality care to our members and look forward to working with you to complete this process.

Key Points

  • HEDIS is required by the Centers for Medicare and Medicaid Services (CMS) for all Medicare Advantage organizations. It is used for the National Committee for Quality Assurance (NCQA) accreditation and to monitor quality initiatives.
  • HEDIS medical record reviews reflect the good care patients receive that cannot be captured via the claims process.
  • Many of you will receive a letter from our Senior Vice President, Chief Medical Officer Rahul Rajkumar, MD, clarifying Blue Cross NC's reason for making these requests. The letter also outlines expectations for these records:
    • "As a reminder, your contract as a participating provider contains language around the provision of the requested records to Blue Cross NC, at no charge, to capture the content of clinical encounters with our members and to allow Blue Cross NC to fulfill reporting requirements."
  • Early in February, you'll receive an email prompting you to log in to Blue e to retrieve your member list with the specific medical records we need.
    • We'll include members' names and dates of birth, as well as guidance for the medical record information requested.
    • You can upload the requested records directly into Blue e via the Clinical Data Exchange.
    • Please send all records within five business days of receiving the medical record request.
  • We want to minimize any negative impacts to your office work flow. The faster we obtain the necessary records, the fewer follow-up contacts will be necessary.

Thank you, in advance, for your prompt response to our requests, and for helping us successfully complete our HEDIS reporting.