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Time To Prepare for HEDIS Medical Record Review (Healthy Blue + Medicare HMO D-SNP) February 09, 2023 Quality-Based Programs

Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

Summary of Update

Each year, Blue Cross NC performs a review of a sample of our members’ medical records as part of the HEDIS® quality study. HEDIS is part of a nationally recognized quality improvement initiative and is used by Medicare and Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), and several states to monitor the performance of managed care organizations.

For 2022, Blue Cross NC will begin requesting medical records in January 2023. No special authorization is needed for you to share member medical record information with us since quality assessment and improvement activities are a routine part of healthcare operations.

Ways to Submit Your Records:

  • Remote electronic medical records (EMR) access service: As we published in the Provider Newsletter, we now offer EMR access to providers to submit member medical record information to Blue Cross NC. If you are interested in more information, please contact us at Centralized_EMR_Team@healthybluenc.com.
  • Upload: Medical records can be uploaded to the Blue Cross NC secure website using the instructions in the request document.
  • Fax: Medical records can be faxed to Blue Cross NC using the instructions in the request document.
  • US Postal Service: Medical records can be mailed to Blue Cross NC using the instructions in the request document.
  • Onsite: Medical records can be pulled by a Blue Cross NC representative at your office where medical records are located.
  • Secure File Transfer Protocol (SFTP): Medical records can be uploaded via secure website set-up by Blue Cross NC.

HEDIS review is time sensitive, so please submit the requested medical records within the time frame indicated in the initial HEDIS request document.

We appreciate the care you provide our members. Your assistance is crucial to ensuring our data is statistically valid, auditable, and accurately reflects quality performance.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

For more information, visit Healthy Blue + Medicare.

NCBCBS-CR-007867-22-CPN7161

January 2023

 

 

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

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