March 2018
How Providers Can Impact HEDIS®
Do the services you provide to your patients count? Blue Cross and Blue Shield of OK (BCBSOK) values the care you provide to our members.
As a provider, you are an important part of the Healthcare Effectiveness Data and Information Set (HEDIS) process because of your role in submitting accurate and timely records. It is time for BCBSOK to prepare for the HEDIS data collection period since select HEDIS measures are included in the Health Insurance Marketplace’s Quality Rating System. The information in this article will help you better understand what is expected of you as a provider and how your compliance positively impacts HEDIS scores.
What is HEDIS?
HEDIS is a collection of performance measures developed by the team of clinicians and researchers at the National Committee for Quality Assurance to measure the effectiveness of health care received by health plan members. Controlling high blood pressure is an example of a current tracked measure. The HEDIS team reviews medical records of members diagnosed with hypertension to identify the percentage of members whose blood pressures are adequately controlled during the measurement year.
How is data collected?
Health plans start collecting data from the previous measurement year in February (i.e., HEDIS 2018 data will measure 2017 performance). Two different methods can be used:
- Administrative Data – obtained from claims
- Hybrid Data – obtained from medical record reviews to augment administrative data rates
How is HEDIS data used?
The results are used by consumers to help them select the best health plan for their needs. Results are also used by health plans to measure performance, identify quality initiatives, and provide educational programs for providers and members.
What about HIPAA?
The Health Information Portability and Accountability Act privacy rule allows the collection and release of HEDIS results with no special patient consent or authorization. Access to member medical records is a contractual requirement that supports this data collection effort.
How can you help as a provider?
The quality of care and services offered by our providers and their staff is reflected in the improvement of HEDIS scores. As a provider, you and your staff can help facilitate the HEDIS process by:
- Documenting accurately in medical records
- Coding all claims accurately
- Responding quickly to our request for medical records within five business days
Non-responses by the provider office count as a negative toward HEDIS scores.
If you have any questions regarding requests for medical records, contact your BCBSOK provider network representative.