Blue Cross and Blue Shield of New Mexico (BCBSNM) collects healthcare effectiveness data annually 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 for the Quality Rating System for services provided in the previous calendar year (2022).
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.
BCBSNM will be collecting medical records to meet these requirements. We ask that your provider office reply within 3 to 5 business days if you receive a request for 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 should be furnished at no cost to BCBSNM.
If you outsource the request to a print vendor, it does not shift the provider responsibility of supplying the medical record timely to BCBSNM. Using a print vendor typically delays the receipt of the medical records and could result in a breach of your provider contract. These activities are considered health care operations under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule. Patient authorization for review of information is not required. It remains the responsibility of the provider to provide the medical record(s) timely.
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 can be requested, if applicable. Your office may receive multiple medical record requests. Please ensure accuracy by reviewing our requests and confirm that your office has the medical records requested for the given measure and timeframe.
Please contact the BCBSNM HEDIS representative listed on our request for medical records if you have any questions or to request on-site appointments.
HEDIS is a registered trademark of NCQA