Records Needed to Support Quality Care for Medicare Advantage Members 

12/18/2024

Medicare Advantage providers may receive medical record requests from Blue Cross and Blue Shield of Texas or our vendor Advantmed from January through June 2025. We collect data for Healthcare Effectiveness Data and Information Set (HEDIS®) measures on the quality of our members’ care and health outcomes.

How you can help: Either BCBSTX or Advantmed may contact you by fax or phone to provide details about the records needed and how to submit them to us. Please promptly provide complete and accurate records.

Patient authorization isn’t required to release these records, as their collection and review is considered a component of health care operations under the Health Insurance Portability and Accountability Act of 1996.

The data we’re seeking: We collect data related to chronic conditions such as diabetes and high blood pressure, and transitional care.

Other record requests throughout the year may include requests related to risk adjustment, focusing on chart reviews and the accuracy of risk-adjustable codes submitted to the Centers for Medicare & Medicaid Services.

Please contact your local Provider Network Office if you have questions.

 

HEDIS is a registered trademark of NCQA.

 

Advantmed, LLC is an independent company that has contracted with BCBSTX to request medical records for HEDIS reporting. BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services they offer.