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Respond to Medical Records Request From Verisk Health to Help Secure HEDIS Credit

Blue Cross and Blue Shield of North Carolina (BCBSNC) recognizes that the demands on providers are greater and more complex than ever before, yet providing quality care remains a top priority. Our goal is to support you in providing members with the highest quality care possible, and help you secure the HEDIS credit you deserve for the vital work you do.

In preparation for the 2014 Healthcare Effectiveness Data and information Set (HEDIS) cycle, we request your assistance in ensuring we have the most accurate data for you/your practice.  As a result, you may receive one or both of the following types of requests:

  • A request for medical records from Verisk Health.  Verisk Health has been contracted to gather medical records on our behalf for our members who live outside of North Carolina.  Verisk Health is contractually bound to preserve the confidentiality of health plan members’ protected health information (PHI) obtained from medical records, in accordance with HIPAA regulations. Please note that patient-authorized information releases are not required in order for you to comply with this request for medical records.  As outlined in your contract, you are required to respond to requests in support of risk adjustment, HEDIS, and other government-required activities within the requested timeframe. This includes requests from Verisk Health.

 

  • A request for medical information from BCBSNC specifically for three HEDIS measures:
    • Avoidance of Antibiotic Treatment With Acute Bronchitis
    • Appropriate Testing for Children With Pharyngitis  
    • Appropriate Testing for Children With Upper Respiratory Infection

If you receive this request, you will be asked to simply attest that you have the appropriate documentation in the patient’s medical record that could be sent to BCBSNC if requested.  If you prefer to send a copy of the medical record that pertains to the requested information, which would also meet our needs to ensure we have the needed information.

Thank you in advance for your assistance, if you receive one or both of the above requests.  Having the appropriate information on file assists us all in ensuring our members, your patients, receive the best care possible.