Jan. 13, 2021
Blue Cross and Blue Shield of Texas (BCBSTX) collects annually performance data using specifications published by the National Committee for Quality Assurance (NCQA) for Healthcare Effectiveness Data and Information Set (HEDIS) and by the U.S. Department of Health and Human Services (HHS) for the Quality Rating System (QRS). HEDIS is the most widely used and nationally accepted effectiveness of care measurement available. Additionally, HHS requires reporting of QRS measures for accredited Qualified Health Plans. These activities are considered health care operations under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule and patient authorization for release of information is not required. Texas state law (Chapter 108 of the Texas Health and Safety Code) requires Health Maintenance Organizations in Texas to report HEDIS data, by service area to the Department of State Health Services (DSHS) on an annual basis.
How Data is Collected
To meet these requirements, BCBSTX will be collecting medical records using Change Healthcare, an independent contracted third-party vendor, as well as BCBSTX staff. If you receive a request for medical records, we encourage you to reply within 3 to 5 business days. Cooperation with the collection of HEDIS and QRS data or any quality improvement activities are required under the providers’ contractual obligation at no cost to BCBSTX or as stated within the provider’s individual contract.
A representative from Change Healthcare, our contracted vendor or BCBSTX staff may be contacting your office or facility anytime between February 2021 through May 2021 to set up appointments for onsite visits or to set up an expected delivery date via fax, provider portal and if necessary, U.S. Mail.
What Providers Need To Do
As part of the request you will receive a letter introducing the background and authorizing agencies for the HEDIS and QRS data request, a medical record request list with members’ names and other identifying demographics, and the medical record information needed for identified measures.
If you have any questions about medical record requests, please contact a representative that will be listed on the provider letter requesting the medical record information.
HEDIS is a registered trademark of NCQA.
Change Healthcare is an independent third-party vendor that is solely responsible for the products or services they offer. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent third-party vendors. If you have any questions regarding the services they offer, you should contact the vendor directly.