BCBSMT Preparing for 2017 HEDIS Measurement Year

Jan. 01, 2018

Blue Cross and Blue Shield of Montana (BCBSMT) is preparing the Healthcare Effectiveness Data and Information Set (HEDIS®) report for the 2017 measurement year. HEDIS is a set of standardized measures developed by the National Committee for Quality Assurance (NCQA) to assess health plan value. Participation in the audit is required by the Centers for Medicare and Medicaid (CMS), URAC Health Plan accreditation and Health Insurance Exchange requirements, as well as Montana’s Managed Care Plan Network Adequacy and Quality Assurance Act. Your cooperation is crucial to ensure that BCBSMT data are complete and accurate.

These activities are considered health care operations under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule, so no additional patient authorization is required. Disclosure of medical information to BCBSMT is permitted by the written consent of our members at the time of initial enrollment in our health benefits program.

BCBSMT may be contacting your office in early February 2018 to identify a contact person and/or determine which type of data collection you prefer.

BCBSMT offers three choices for you or your office staff to provide the required medical record information:

1. Faxing of pertinent medical record documentation (406-437-5860); OR

2. Remote access to your electronic health records (EHR); OR

3. Allowing a health plan representative to review and copy records on site.

A Patient List and Chart Copy Instructions will be attached to our request for medical records. The Chart Copy Instructions will give examples of medical record documentation to be sent to BCBSMT. If you receive a request for medical records, we encourage you to reply within 3 to 5 business days.

If you have any questions, please contact the BCBSMT QI staff at either (406) 437-6827). BCBSMT values your support of our efforts to measure and improve quality. Thank you for your continued cooperation. Additional information regarding HEDIS is also available at www.ncqa.org.