Medical Record Review for HEDIS Measurement Year 2021 Begins in February

In the coming weeks, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin collecting 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 reflect the care patients receive that is not captured during 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. 

Early in February, a Blue Cross NC representative will contact your office to verify contact information. Requests will be sent through Blue e and will contain 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 in Blue E through 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 on your office workflow.  The quicker you comply with our requests, and we receive the necessary medical records, it will eliminate the need for follow-up phone calls to your office.  Thank you, in advance, for your prompt response to our requests and for helping us successfully complete our HEDIS reporting.