HEDIS Measurement Year 2024 Medical Record Review begins February 2025

In the coming weeks, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will collect our members’ medical records for the annual Healthcare Effectiveness Data and Information Set (HEDIS®) reporting requirements. The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage Organizations and Qualified Health Plans on Exchange (s) to report HEDIS results, as does the National Committee for Quality Assurance (NCQA) for accreditation and quality initiative monitoring. HEDIS Medical Record Review reflects the care patients receive that is not captured through the claims process.

Starting in early February, a Blue Cross NC representative will contact your practice to verify contact information and then send a list of medical records we need for members in your care. We will include the member’s name and date of birth, as well as guidance for the medical record information being requested. You will be able to upload the records requested into Blue e through the Clinical Data Exchange or you may fax the medical records.

Please send all records within five business days of receiving the medical record request.

We want to minimize any disruptions to your office workflow. The sooner we obtain the requested records, the fewer follow-up contacts will be necessary.

Thank you for your prompt response to our requests, and for helping us successfully complete our HEDIS reporting. We appreciate your commitment to providing high-quality care to our members and look forward to working with you to complete this process.

If you have any questions, please contact Quality.Management@bcbsnc.com.

HEDIS is a registered mark of the National Committee for Quality Assurance.