Your partnership is important to us and our members. Important changes are coming to Healthcare Effectiveness Data and Information Set (HEDIS)^® reporting methods. The National Committee for Quality Assurance (NCQA) has a proposed timeline for transitioning to a fully digital quality measurement by 2030, phasing out the hybrid method by 2029. 

Instead of hybrid sampling, NCQA will require full population reporting for Electronic Clinical Data Systems (ECDS) or administrative designated measures, offering a clearer picture of health care quality. See this NCQA blog post for additional information. 

In alignment with this transition, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement a year-round medical record review process for select measures based on NCQA HEDIS specifications. The process will involve proactive outreach to providers or Health Information Management (HIM) departments to obtain medical records for members with identified care gaps. When possible, existing medical record request workflows and provider contacts will be leveraged to streamline retrieval efforts. The focus is to close quality care gaps throughout the measurement year, supporting continuous quality improvement as NCQA transitions away from hybrid sampling. 

Blue Cross NC encourages providers to prioritize claims coding and standard supplemental data extracts as the primary methods for closing care gaps while optimizing electronic health record (EHR) systems for digital reporting. Year-round medical record review will complement these approaches by enabling targeted claims-based chases when applicable. Additionally, any care gaps closed using year-round medical record review may benefit provider groups participating in incentivized programs for attributed members. 

We will continue to communicate relevant updates and provide guidance throughout this transition. 

If you have any questions or need further clarification, please email the Quality Management team at Blue Cross NC.