Thank you for participating in the annual Healthcare Effectiveness Data and Information Set (HEDIS®) commercial data collection project for 2018. You play a central role in promoting the health of our members. By documenting services in a consistent manner, it is easy for you to track care that was provided and identify any additional care that is needed to meet the recommended guidelines.  Consistent documentation and responding to our medical record requests in a timely manner eliminates follow up calls to your office and also helps improve HEDIS scores, both by improving care itself and by improving our ability to report validated data regarding the care you provided. The records that you provide to us directly affect the HEDIS results that are listed below.

Each year our goal is to improve our process for requesting and obtaining medical records for our HEDIS project. In order to demonstrate the exceptional care that you have provided to our members and in an effort to improve our scores, you and your office staff can help facilitate the HEDIS process improvement by:

 

  • Responding to our requests for medical records within five days, if possible
  • Providing the appropriate care within the designated timeframes
  • Accurately coding all claims
  • Documenting all care clearly in the patient’s medical record

Further information regarding documentation guidelines and administrative codes can be found on the HEDIS page of our Provider Portal.  In addition more information on HEDIS can be found by visiting the provider portal at: www.anthem.com > Provider > Choose State > Find Resources > Health & Wellness (top blue bar) > Quality Improvement and Standards > HEDIS Information. You will find reference documents entitled “HEDIS 101 for Providers” and “HEDIS Physician Documentation Guidelines and Administrative Codes”.

 

The attached table shows some of our key measure rates across California.

 

  • Yellow boxes indicate rates that are above the national average.
  • Bold indicates improvement in rate over the previous year.
  • B/R = Biased Rate, NR = Not Reported, NA = Not Applicable - denominator too small
  • Comprehensive Diabetes Care - Poor HbA1c Control (>9): Lower rate is good

 



Featured In:
December 2018 Anthem Blue Cross Provider Newsletter - California