Quality ManagementMedicare AdvantageOctober 25, 2024

Time to prepare for HEDIS medical record review

At a glance:

      • Care providers must prepare for HEDIS® medical record reviews starting January 2025.
      • Care providers will submit records through Remote Electronic Medical Record (EMR) Access Service, website upload, fax, secure file transfer protocol (SFTP), mail, or on-site.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Background

Each year, we perform 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 the Centers for Medicare & Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), and several states to monitor the performance of managed care organizations.

We will begin requesting medical records in January 2025. No special authorization is needed for you to share member medical record information with us since quality assessment and improvement activities are routine parts of healthcare operations.

Ways to submit your records in our preferred order:

      • Remote EMR Access Service: We offer the Remote EMR Access Service to care providers to submit member medical record information to us. If you are interested in more information, contact us at Centralized_EMR_Team@anthem.com.
      • Upload: Medical records can be uploaded to our secure website using the instructions in the request document.
      • Fax: Medical records can be faxed to us using the instructions in the request document.
      • SFTP: Medical records can be uploaded via a secure website.
      • U. S. Postal Service: Medical records can be mailed to us using the instructions in the request document.
      • On-site: Medical records can be pulled by a representative at your local office where medical records are located.

HEDIS review is time sensitive, so submit the requested medical records within the timeframe 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.

Contact us

Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to https://Availity.com and select the appropriate payer space tile from the drop-down. Then, select Chat with Payer and complete the pre-chat form to start your chat.

For additional support, visit the Contact Us section of our provider website for the appropriate contact.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Blue Medicare Advantage is the trade name of Group Retiree Health Solutions, Inc., an independent licensee of the Blue Cross Blue Shield Association.

PAIBC-CR-069950-24-CPN69632, PAIBC-CR-071182-24-CPN71157