2022 Annual HEDIS® Medical Record Review Begins February 2022

January 13, 2022

Annually, Blue Cross and Blue Shield of New Mexico (BCBSNM) collects healthcare effectiveness data through medical record chart review for reporting to the National Committee for Quality Assurance (NCQA) and the U.S. Department of Health and Human Services (HHS) for the Quality Rating System (QRS) for services provided in the previous calendar year (2021). The Healthcare Effectiveness Data and Information Set (HEDIS) are performance measures that measure quality of care and outcomes. HEDIS performance measures are developed and maintained by NCQA® and is the most widely used set of performance measures utilized by the managed care industry.

To meet these requirements, BCBSNM will be requesting and collecting medical records using internal resources. Should your provider office receive a request for medical records, a reply is requested within 3 to 5 business days to ensure timely collection of medical records. Cooperation with the collection of HEDIS data is part of BCBSNM’s quality improvement activities and is required under your contractual obligation with BCBSNM. Medical records will be furnished at no cost to BCBSNM. These activities are considered health care operations under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule and patient authorization for review of information is not required.

A BCBSNM representative may be contacting your office or facility to ensure accuracy and timely submission of requested medical records. On-site appointments for medical record retrieval may be requested and scheduled, if applicable. Please be aware, that your office may get more than medical records request. Please ensure accuracy by reviewing our requests and confirm that your office has the medical records requested for the given measure and timeframe requested. Should you have any questions regarding our request for medical records, or on-site appointments, please contact the BCBSNM HEDIS representative listed on our request for medical records.

HEDIS is a registered trademark of NCQA