BCBSIL Medical Record Retrieval Summary

March 4, 2022

Blue Cross and Blue Shield of Illinois (BCBSIL) or a contracted vendor may be contacting you in the coming months for patient medical records for audits, Healthcare Effectiveness Data and Information Set (HEDIS®) data collections or other programs. To help you keep track of the initiatives and vendors, we’ve summarized the information below:

Record Collection Dates Name of Initiative Member Type Vendor or BCBSIL

January – April 2022

Medicaid HEDIS Medical Record Data Collection


Episource and BCBSIL 

January – April 2022

HEDIS Medical Record Data Collection

Commercial and Retail HMO and Retail PPO


January – April 2022

Federal Employee Program® (FEP®) HEDIS Medical Record Data Collection


Episource and BCBSIL FEP staff 

January – May 2022

Medicare Advantage HEDIS Medical Record Data Collection

Medicare Advantage

Episource and BCBSIL 

January – October 2022

Commercial PPO Medical Record Data Collection

Commercial PPO


May 2022 – January 2023

2021 Health and Human Services Risk Adjustment Data Validation (HHS-RADV)/Initial Validation Audit (IVA)

Affordable Care Act (ACA)-compliant individual and small group plans


June – December 2022

Quality Improvement (QI) Project




Patient authorization for release of medical record data is not required. These reporting activities are considered health care operations under the Health Information Portability and Accountability Act (HIPAA) of 1996 and its implementing regulations (45 C.F.R. Parts 160 and 164), and the Health Information Technology for Economic and Clinical Health (HITECH) Act, as incorporated in the American Recovery and Reinvestment Act (ARRA) of 2009, and its implementing regulations, each as issued and amended. We appreciate your time and continued collaboration. If you have any questions about medical record requests, please contact your assigned Provider Network Consultant (PNC).


HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here. The NCQA HEDIS measure specification has been adjusted pursuant to NCQA’s Rules for Allowable Adjustments of HEDIS. The adjusted measure specification may be used only for quality improvement purposes.