Jan. 15, 2025
Providers who care for our commercial members may receive medical record requests from us beginning Feb. 1, 2025. We collect performance data using specifications published by the National Committee for Quality Assurance for Healthcare Effectiveness Data and Information Set (HEDIS®) and by the Centers for Medicare & Medicaid Services for the Quality Rating System.
Why is this needed? Both NCQA and CMS require reporting of quality measures, which impact accreditation. These activities are considered health care operations under the Health Insurance Portability and Accountability Act Privacy Rule. Patient authorization isn’t required to release this information.
How you can help: Please respond to our requests for medical records within five to seven business days. Our requests will include a member list identifying the minimum information required. The records you provide help us validate the quality of care provided to our members.
How to Submit Records
Remote submission or secure email: Several provider organizations and hospitals have provided us direct access to electronic medical records. This allows us to extract only the required information we need. Email us to set up remote EMR access or to submit through secure email.
If remote submission or secure email isn’t an option, you may submit records by fax or mail.
Fax: Attn: HEDIS Reviewer
918-549-2349
Mail: Blue Cross and Blue Shield of Oklahoma
Attn: HEDIS
1400 S. Boston Ave., FL 3
Tulsa, OK 74119-3613
Medical record vendors: If you work with a third-party vendor to provide medical records, please instruct them to return the requested information within five to seven business days of the request using the secure email or fax listed above.
If you have questions about HEDIS records requests, email our HEDIS department.
Providing requested medical records without charge to support medical management, quality management, compliance and other programs is included in your provider agreement with us. If you use a vendor, ensure they are aware of this requirement. If you have questions about your provider agreement, call Network Management at 1-800-722-3730, Option 2, or email.
HEDIS is a registered trademark of NCQA.