Thank you for participating in the annual Healthcare Effectiveness Data and Information Set (HEDIS) commercial data collection project for 2018, impacting members enrolled in our Anthem PPO and Anthem HealthKeepers (excluding Medicaid) commercial products.  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 in the attachment.


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 HEDIS process improvement by:


  • Responding to our requests for medical records within five days if at all possible


  • Providing the appropriate care within the designated timeframes


  • Accurately coding all claims


  • Documenting all care clearly in the patient’s medical record


Select the attachment to the right to view HEDIS information including 2018 HEDIS results


In addition to the information in the attachment, further information regarding documentation guidelines and administrative codes can be found on the HEDIS page of our Provider Portal.  More information on HEDIS can be found by visiting the provider portal at: > Provider > Choose Virginia > 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 information in the attachment pertains only to our Anthem PPO and Anthem HealthKeepers commercial lines of business and does NOT include results for Anthem HealthKeepers Plus [Medicaid and Commonwealth Coordinated Care Plus (Anthem CCC Plus)], Medicare Advantage, or the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program® or FEP®).




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


Featured In:
December 2018 Anthem Provider Newsletter - Virginia