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®1) reporting requirements. HEDIS is required by The Centers for Medicare & Medicaid Services (CMS) for all Medicare Advantage organizations. It is used for the National Committee for Quality Assurance (NCQA) accreditation, and quality initiatives.

HEDIS Medical Record Reviews
HEDIS medical record reviews reflect the care patients receive that is not captured via the claims process. We appreciate your commitment to providing high-quality care to our members and look forward to working with you to complete this process.

Many of you will receive a letter from our Senior Vice President, Chief Medical Officer Von Nguyen, MD, clarifying Blue Cross NC’s reason for making these requests. This letter also outlines the expectations for these records. The letter states:

“As a reminder, your contract as a participating provider has 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. “

Actions for Providers
Early in February, a Blue Cross NC representative will contact your office to verify contact information and fax your member list with the specific medical records we need. We will include the member’s name and date of birth, as well as guidance for the medical record information being requested. You will be able to upload the records requested into Blue e via the Clinical Data Exchange or you may fax the medical records.

Please send all records within five business days of receiving the medical record request.
We want to minimize any negative impacts on your office workflow. 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.


®1 HEDIS is a registered mark of National Committee for Quality Assurance