2019 Annual HEDIS Medical Record Review begins February 2019

January 16, 2019

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). The Healthcare Effectiveness Data and Information Set (HEDIS® ) are performance measures that measure care and service performance. 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 collecting medical records using internal resources. If you receive a request for medical records, we request you reply within 3 to 5 business days. Cooperation with the collection of HEDIS data or any quality improvement activities is required under a providers’ contractual obligation 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 anytime between January and April 2018 to request a patient’s medical record. Appointments for onsite visits will be scheduled with your staff, if applicable. If you have any questions about a HEDIS medical record request, please contact the BCBSNM HEDIS representative at the phone number listed on the letter that is attached to the medical record request.

HEDIS is a registered trademark of NCQA.