December 2016

Reminder: Annual Medical Record Data Collection for Quality Reporting Begins Feb. 1, 2017

Blue Cross and Blue Shield of Texas (BCBSTX) collects performance data using specifications published by the National Committee for Quality Assurance (NCQA) for Healthcare Effectiveness Data and Information Set (HEDIS) and by the U.S. Department of Health and Human Services (HHS) for the Quality Rating System (QRS).

HEDIS is the most widely used and nationally accepted effectiveness of care measurement available and HHS requires reporting of QRS measures. These activities are considered health care operations under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule and patient authorization for release of information is not required. Additionally, Texas state law (Chapter 108 of the Texas Health and Safety Code) requires Health Maintenance Organizations (HMO) in Texas to report HEDIS data by service area to the Department of State Health Services (DSHS) on an annual basis.

To meet these requirements, BCBSTX will be collecting medical records using internal resources and leveraging independently contracted third-party vendor, CIOX. If you receive a request for medical records, we encourage you to reply within 3 to 5 business days. Cooperation with the collection of HEDIS data or any quality improvement activities are required under providers’ contractual obligation at no cost to BCBSTX or as stated within the provider’s individual contract.

A BCBSTX representative or a representative from CIOX may be contacting your office or facility anytime between December 2016 to February 2017 to identify a key contact person, and to ascertain which data collection method your office or facility prefers (fax, secure email or on-site). Appointments for on-site visits will be scheduled with your staff, if applicable. You will then receive a letter outlining the information that is being requested, and the medical record request list with members’ names and the identified measures that will be reviewed.

If you have any questions about medical record requests, please contact a BCBSTX representative at the phone number listed on your provider letter.

HEDIS is a registered trademark of NCQA.

CIOX is an independent third party vendor that is solely responsible for the products or services they offer. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions regarding the services they offer, you should contact the vendor directly.