Time to prepare for HEDIS medical record review

Each year, Anthem performs a review of a sample of our members’ medical records as part of the HEDIS^® quality study. HEDIS is part of a nationally recognized quality improvement initiative and is used by Centers for Medicare and Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), and several states to monitor the performance of managed care organizations.

For 2022, Anthem will begin requesting medical records in January 2023. No special authorization is needed for you to share member medical record information with us since quality assessment and improvement activities are a routine part of healthcare operations.

Ways to submit your records:

• Remote electronic medical records (EMR) access service: As we published in the Provider Newsletter, we now offer EMR access to providers to submit member medical record information to Anthem. If you are interested in more information, please contact us at Centralized_EMR_Team@anthem.com.
• Upload: Medical records can be uploaded to the Anthem secure website using the instructions in the request document.
• Fax: Medical records can be faxed to Anthem using the instructions in the request document.
• U.S. Postal Service: Medical records can be mailed to Anthem using the instructions in the request document.
• Onsite: Medical records can be pulled by an Anthem representative at your office where medical records are located.
• Secure File Transfer Protocol (SFTP): Medical records can be uploaded via secure website set up by Anthem.

HEDIS review is time sensitive, so please submit the requested medical records within the time frame indicated in the initial HEDIS request document.

We appreciate the care you provide our members. Your assistance is crucial to ensuring our data is statistically valid, auditable, and accurately reflects quality performance.