Health care payment plans started sending letters to physician offices in February to begin this year's annual Healthcare Effectiveness Data and Information Set (HEDIS) data collection process. No two health plans collect their HEDIS data exactly the same way, but most follow similar processes.
Health plans typically first want to know your preferred delivery method, such as fax, email, or secure access to your electronic medical record system, for sending requested patient records. You also may be asked to schedule an on-site visit with a plan representative. If you receive a medical records request, make sure you respond within the requested time frame.
Refer to your contract before charging a health plan for expenses related to medical record data collection.
You can view notices to providers about HEDIS data collection and more information from some major health plans:
- The Blue Cross and Blue Shield of Texas (BCBSTX) HEDIS data collection methods may include an on-site visit from a BCBSTX nurse.
- Cigna may send you its medical records review list of patient names in its initial letter with a deadline for submission.
- UnitedHealthcare (UHC) first sends a general notification letter to the offices of all contracted physicians and providers. If your patient(s) is selected for review, a UHC representative will contact your office to schedule a date for collecting the data and, on that same day, will fax you a list of patient names. You can choose electronic or on-site data collection, fax, mail, or email. You may be contacted by one of UHC's medical record vendors: Altegra Health, Enterprise Consulting Solutions, Inc., HealthPort, or Record Flow.
- Aetna's medical records vendors, HealthPort or MedSave, may contact your office to schedule data collection. For more information, see page 6 of this Aetna newsletter.
- Tricare's HEDIS program information is on page 3 of this newsletter.
The National Committee for Quality Assurance develops and maintains HEDIS quality measures that are used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. HEDIS consists of 81 measures updated yearly across five domains of care.
If you have questions about HEDIS, email TMA's specialists or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Also, visit the TMA Payment Advocacy Services webpage and TMA's Payer page for more resources and information.
Action, March 2, 2015
Last Updated On
May 13, 2016