December 2016
Important HEDIS® 2017 Pre-season Information
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, Texas Health and Human Services Commission (HHSC), the Institute for Child Health Policy (ICHP) and the External Quality Review Organization (EQRO) contracted by HHSC.
For HEDIS HYBRID 2017, BCBSTX has identified the following measures for performance review:
- Childhood Immunization Status (CIS)
- Well-child visits in the first 15 months of life (W15)
- Well-child visits in the 3rd, 4th, 5th and 6th years of life (W34)
- Adolescent Well-care Visits (AWC)
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)
- Prenatal and Postpartum Care (PPC)
- Comprehensive Diabetes Care (CDC)
- Controlling High Blood Pressure (CBP)
While we use claims data as much as possible, some of these measures require that we obtain information directly from patient medical records kept at the physician’s office. 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 completed during an office visit or by fax of records.
Please note that collecting this documentation is permissible under the privacy regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) 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 contact Kathleen Thompson at 512-349-4836 or by e-mail.
We will be sending a separate notice in January near the beginning of HEDIS season.
We greatly appreciate your assistance and the care you provide our members and your patients.
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).