HEDIS measurement year 2025 medical record review begins in February 2026

In the coming weeks, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will collect our members’ medical records for the annual Healthcare Effectiveness Data and Information Set (HEDIS^®1) reporting requirements. The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage Organizations and Qualified Health Plans on Exchange(s) to report HEDIS results, as does the National Committee for Quality Assurance (NCQA) for accreditation and quality initiative monitoring. HEDIS Medical Record Review reflects the care patients receive that is not captured through the claims process.

Starting in February 2026, a Blue Cross NC representative will contact providers to verify contact information, and in early February send providers their member list with the specific medical records we need, if required of their practice. We will include the member’s name and date of birth, as well as guidance for the medical record information being requested. Providers will be able to upload the records requested into Blue e through the Clinical Data Exchange or may fax the medical records.

Please send all records within five business days of receiving the medical record request.

We want to minimize any disruptions to providers’ office workflow. The sooner we obtain the requested records, the fewer follow-up contacts will be necessary.

Thank you to providers for your prompt response to our requests, and for helping us successfully complete our HEDIS reporting. We appreciate your commitment to providing high-quality care to our members and look forward to working with you to complete this process.

Providers can contact Quality.Management@bcbsnc.com with any questions.