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New Options for Affordable Health Insurance

MA PAP504

HEDIS® Survey


Provider Administrative Policy

Section
Care Management
Policy Date
May 2008
Status/Date
Revised/November 2008

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

HEDIS® Survey

HEDIS® (Healthcare Effective and Data Information Set) is an annual collection of data that assesses the status of health plans' preventive health maintenance activity levels and allows health plans to compare data. HEDIS® provides data for quality improvement programs and processes. The Centers for Medicare and Medicaid Services (CMS) requires Medicare Advantage plans to participate in the HEDIS survey. From January through June of each year, a representative from Blue Cross of Idaho Medical Quality Management Medicare Advantage may notify you of the measures requiring medical record review and send a list of the medical records necessary for review. A Blue Cross of Idaho representative may come to your office to review and extract the information required. The data is audited per CMS requirements and therefore providers may be requested to provide copies of the pages of some medical records that support abstracted information.

 A complete copy of the HEDIS report is available from provider services upon request.

If you have further questions regarding the HEDIS abstraction process, please call the Quality Improvement manager at Blue Cross of Idaho (See MA PAP102 ).


Policy History

Date Action Reason
November 2008 Revised Contact information link added
May 2008 Revised Language clarification

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