What Is HEDIS?
Healthcare Effectiveness Data and Information Set (HEDIS) is the measurement tool used by health plans to evaluate their performance in terms of clinical quality and customer service. It is coordinated and administered by the National Committee for Quality Assurance (NCQA) and used by Centers for Medicare & Medicaid Services (CMS) for monitoring the performance of health plans.
HEDIS Results
Results are used to measure performance, identify quality initiatives and provide educational programs for providers and members. CMS requires Medicare Advantage plans and Qualified Health Plans with Marketplace products to participate in the HEDIS audit. BCBSOK may require copies of the pages of some medical records as supportive documentation.
What is the BCBSOK Provider’s Role in HEDIS?
Our providers play an important role in promoting the health of our members. When supporting medical records are required, you and your staff can assist with the HEDIS process improvement by responding to our requests within 5-to-7 business days. The records you provide as part of this process will help us validate the quality of care provided to our members.
Medical Records Requests
Medical record requests sent to the provider include a member list identifying the minimum necessary information required. Due to the shortened timeframe, a 5-to-7 business day turnaround time is appreciated.
Remote Submission
We partner with several provider organizations and hospitals to receive direct electronic medical records (EMR) access. This allows us to extract only the required information we need. For more information about setting up remote EMR access, please contact Shannon_Davis@bcbsok.com.
Other Methods
If remote submission is not an option, secure email, fax and mail is available.
Secure email: OKHEDIS@bcbsok.com
Fax: Attn: HEDIS Reviewer
918-549-2349
Mail: BCBSOK
Attn: HEDIS
1400 S. Boston Ave., FL 3
Tulsa, OK 74119-3613
Records may also be uploaded using the online tool located on the Availity® Provider Portal at https://www.bcbsok.com/provider/education/education-reference/tools/erm.
If records are uploaded to the Availity® portal, please send an email to the HEDIS Department (OKHEDIS@bcbsok.com) with the tracking number so the uploaded records can be retrieved.
Medical Record Vendors
If you work with a third-party vendor to provide medical records, please instruct them to return the requested information within 5-to-7 business days of the request by:
- Sending a secure email to OKHEDIS@bcbsok.com
- Faxing records to Attn: HEDIS Reviewer @ 918-549-2349
If you have questions regarding HEDIS records requests, please submit an email to our HEDIS Department at OKHEDIS@bcbsok.com.
As a reminder, providing requested medical records without charge to support medical management, quality management, compliance and other programs is included in your BCBSOK provider agreement. If you use a vendor, please ensure they are aware of this requirement. If you have questions about your provider agreement, please contact OK Network Management at 1-800-722-3730, Option 2, or submit an email to OKNetworkManagement@bcbsok.com.