HEDIS Medical Records Review

December 14, 2018
HEDIS Medical Records Review

Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures designed to enable consumers to compare performance across health plans.

QualChoice is compiling data for reporting on our 2018 clinical outcomes to measure performance against the HEDIS standards. We have contracted with Complete Provider Resource in accordance with the privacy regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to collect medical records needed for HEDIS reporting on our behalf.

This agreement allows Complete Provider Resource to perform activities involving the use or disclosure of individually identifiable health information on behalf of QualChoice. Complete Provider Resource personnel will contact your office by fax and telephone to coordinate record collection.

Most provider contracts do not require QualChoice or Complete Provider Resource to pay for copies of medical records. Please do not remit invoices for copy charges. If you use a vendor to provide copies of medical records, they may not be eligible to bill QualChoice or Complete Provider Resource. Refer to your provider contract for details, usually outlined in Section 5.2 of your agreement.

An Authorization for Release of Information is not required from the member. QualChoice is a Business Associate, as defined by HIPAA, and is allowed to gather such information in accordance with the Treatment, Payment and Operations guidelines within the Privacy Rule.

For questions or concerns about the HEDIS data collection, please contact your QualChoice Provider Relations Representative at 800.235.7111 or email providerrelations@qualchoice.com.

View provider letter.

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