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 | Medicaid |
Episource and BCBSIL |
January – April 2022 |
HEDIS Medical Record Data Collection |
Commercial and Retail HMO and Retail PPO | BCBSIL |
January – April 2022 |
Federal Employee Program® (FEP®) HEDIS Medical Record Data Collection |
FEP |
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 |
BCBSIL |
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 |
BCBSIL |
June – December 2022 |
Quality Improvement (QI) Project |
HMO |
BCBSIL |
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.