Annual HEDIS® project begins February 2012     
During the next few months, BCBSNM nurses will be contacting your office or facility in preparation for the gathering of information for the nationally validated Healthcare Effectiveness Data and Information Set (HEDIS).

In 2012, BCBSNM will offer alternative methods of medical record data collection aside from performing on-site office visits. In an effort to decrease interruption of the day-to-day functions of provider offices, BCBSNM is providing the options of faxing requested medical records to BCBSNM or sending electronic medical records via secure e-mail.

You may wonder if these activities are permissible under the privacy regulations of the Health Insurance Portability and Accountability Act (HIPAA) of 2006 and whether a specific authorization is required from your patients (our members) prior to releasing copies of medical records to our nurses. Under the “payment and health operations” provision of HIPAA, a special authorization is not needed for you to provide these medical records.

According to the HIPAA Privacy Rule (CFR 160, 164), a health care provider can disclose protected health information (PHI) to health plans for quality assurance, quality improvement, and accreditation activities. A provider is permitted to disclose PHI to a health plan for HEDIS data collection without authorization from the patient when both the provider and the health plan have a relationship with the patient and the information relates to that relationship (45 CFR 164.506 [c][4]).

A BCBSNM nurse will be contacting your office or facility in February to obtain a key contact and to ascertain which data collection method your office or facility prefers (fax, secure e-mail, or on-site). Appointments for on-site visits will be scheduled with your staff. You will then receive a letter outlining the information that is being requested, and the medical record pull list with members’ names and the identified measures that will be reviewed. If you have questions about HEDIS nurse visits or alternative means of data collection please contact Nicole Casados, RN, at (505) 816-2238. We will report aggregated HEDIS results in an upcoming issue.

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

Blue Review • February 2012 • bcbsnm.com