January 2018

The HEDIS^® 2018 Season Is Upon Us

Blue Cross and Blue Shield of Texas (BCBSTX) complies with state and national demands for accountability by collecting performance data using the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is the most widely used and nationally accepted effectiveness of care measurement tool available. The results are utilized each year by health plans, the Texas Health and Human Services Commission, the Institute for Child Health Policy and the External Quality Review Organization contracted by HHSC.

For HEDIS HYBRID 2018, BCBSTX has identified the following measures for performance review:

While we use claims data as much as possible, some of these measures require that we obtain information directly from patient medical records that are kept at physicians’ offices. BCBSTX will contact your office with a list of patients (chase list) whose medical records need to be reviewed. The medical record review of the required patient records may be sent by faxing records to our secure line or, if necessary, during an office visit for extraction of records.

If your office uses a third-party vendor for medical records, please notify us immediately so that steps can be taken to obtain the necessary records in a timely manner. To reach the network management department for notification, please email: TexasMedicaidNetworkDepartment@bcbstx.com.

Please note that collecting this documentation is permissible under the privacy regulations of the Health Insurance Portability and Accountability Act of 1996 that became effective April 14, 2003. This activity is considered routine and a separate authorization from the patient is NOT needed for this requested disclosure.

If you have any questions, please email Kathleen Thompson or call her at 512-349-4836, or you can email Julie Sones or call her at 512-795-5904.

We greatly appreciate your assistance, and the care you provide our members and your patients.

HEDIS is a registered trademark of NCQA.