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Allowed Documentation for HEDIS Follow Up After Hospitalization Measure

HEDIS® Follow Up After Hospitalization (FUH) is a performance measure from the National Committee for Quality Assurance (NCQA), which is annually reported to NCQA by America’s health plans to measure performance.

NCQA has changed their rules about what is considered allowed documentation required to support the FUH measure.  Only member follow-up visits that are supported by a claim, encounter or note from the provider’s medical chart will be allowed as evidence for the purposes of 2014 HEDIS measures (meaning 2013 actual dates of service).

BCBSNC delegates mental health and substance abuse administration to Magellan Health Services.  Allowing Magellan’s authorized follow-up specialist staff to obtain patient information for appropriate ambulatory follow-up purposes complies with the HIPAA Privacy Rule.  

In order to demonstrate that our members are receiving appropriate follow-up care following an inpatient hospital stay, BCBSNC is required by NCQA to obtain evidence of aftercare follow-up treatment.

In order to assist us with collecting this required evidence, Magellan may seek this information from your office on our behalf as part of our case management and/or care coordination activities to help ensure that BCBSNC members receive the best possible care.

What is considered allowed documentation evidence?

  • Claims for services rendered and sent to BCBSNC by provider for payment.
  • Note from the member’s medical chart with identifying provider information attached.
  • Encounter form faxed to provider from Magellan requesting confirmation of services rendered.

 Important Billing Information: Please remember to file all claims to BCBSNC by the end of the year, as this enables us to reconcile with NCQA and other entities for timely reporting. 

If you have any questions, please call the Provider Blue LineSM at 1.800.214.4844.