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. The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage Organizations and Qualified Health Plans on Exchange(s) to report HEDIS results, as does the National Committee for Quality Assurance (NCQA) for accreditation and quality initiative monitoring. 

HEDIS Medical Record Review reflects the care patients receive that is not captured via the claims process. 

Many of you will be receiving a letter from our Chief Medical Officer, Dr. Marcus Wallace, 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.” 

A Blue Cross NC representative will contact your office to verify contact information, and in early February send 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 5 business days of receiving the medical record request. 

We want to minimize any negative impacts on your office workflow, so the faster we obtain the requested records, the fewer follow-up contacts will be necessary. Thank you for your prompt response to our requests and for helping us successfully complete our HEDIS reporting. We appreciate your commitment to providing high-quality care to our members and look forward to working with you to complete this process. 

If you have any questions, please contact Quality.Management@bcbsnc.com.