Expect HEDIS Records Requests From Third Parties
By Ellen Terry

BCBSTX_Preauth

If a company called Ciox Health contacts your office on behalf of Blue Cross and Blue Shield of Texas (BCBSTX) or UnitedHealthcare (UHC), it is because both insurers have contracted with Ciox to collect performance data they are required by law to report.

UHC also is working with Avant-Med, Change Healthcare, and Optum to coordinate records collection for the Healthcare Effectiveness Data and Information Set (HEDIS). BCBSTX says it is collecting data for HEDIS and the U.S. Department of Health and Human Services Quality Rating and Improvement System.

If your practice is one of those randomly selected over the next few months for a medical records request, you’ll receive a list of the records and information needed for certain quality measures. Note that you are required to participate in this data collection as part of your contractual obligation to the payers. Both payers encourage you to reply to any such requests within five business days.

If you have any questions about record requests, contact the representative listed on the letter you receive.

Source: UHC Network Bulletin and BCBSTX Blue Review, January 2019

The Texas Medical Association’s payment specialists continuously review health care payment plans’ newsletters and updates for items important to Texas physicians. Texas Medicine Today periodically publishes key excerpts from those newsletters that you might have missed. Publishing this news or these excerpts does not imply that TMA supports or approves of the changes announced or discussed.

If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, 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. Visit www.texmed.org/GetPaid for more resources and information. 

Last Updated On

February 28, 2019

Originally Published On

February 28, 2019

Related Content

Blue Cross Blue Shield | Insurance

Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

More stories by Ellen Terry