Blue Cross and Blue Shield of North Carolina (Blue Cross NC) values your continued partnership in serving our members. Below are important updates related to 2026 Healthcare Effectiveness Data and Information Set (HEDIS)^® reporting requirements and how upcoming changes may affect your practice.

NCQA transition to digital measurement

The National Committee for Quality Assurance (NCQA) continues to advance toward its goal of fully digital quality measurement by 2030. As part of this effort:

• Hybrid reporting is expected to be phased out by 2029
• NCQA is moving away from hybrid sampling methodologies
• Greater emphasis is being placed on full population reporting using:
  • Electronic Clinical Data Systems (ECDS)
  • Administrative designated measures

These changes are designed to improve consistency, reduce sampling variability, and provide a more comprehensive view of healthcare quality. Additional details are available in this recent NCQA update.

Blue Cross NC requirements alignment

To align with these upcoming NCQA requirements, Blue Cross NC will continue a year-round medical record review (MRR) process in 2026 for select measures, in accordance with NCQA HEDIS specifications.

Key components of this process include:

• Proactive outreach to provider offices or Health Information Management (HIM) departments
• Request for medical records for members with identified care gaps
• Use of existing medical record retrieval workflows and established provider contacts whenever possible to support efficiency and minimize administrative burden
• Ongoing care gap closure throughout the measurement year, rather than during a single reporting period

This year-round approach supports continuous quality improvement and prepares providers and health plans as NCQA shifts away from hybrid sampling.

What providers should do

To support accurate and efficient HEDIS reporting, providers are encouraged to:

• Prioritize accurate and timely claims coding
• Use standardized supplemental data extracts when feasible
• Continue optimizing Electronic Health Record (EHR) systems for digital reporting

The year-round MRR process is intended to complement – not replace – these approaches by enabling targeted chases when necessary.

Benefit to providers

Closing care gaps through this ongoing MRR process may also support provider groups participating in eligible value-based or incentive programs for their attributed members.

Additional updates

Blue Cross NC will continue to share updates and guidance as this multi-year transition progresses. We appreciate your continued collaboration and commitment to improving quality outcomes for our members.

For questions or additional clarification, please contact the Blue Cross NC Quality Management team.