Highmark Announces Annual HEDIS Medical Record Reviews to Begin February 2018

Highmark has announced – via a NaviNet Plan Central notice posted on Jan. 17, 2018 – that its annual Healthcare Effectiveness Data and Information Set (HEDIS) medical record reviews will occur from February to mid-May 2018. The reviews will be based on 2017 measurement year data.

Health care providers may also be contacted by representatives from Highmark, Capital Blue Cross, and Independence Blue Cross for medical records to assist with HEDIS reporting requirements for the Federal Health Program.

A random sample of members will be selected for the reviews. You may receive a telephone or fax contact from one of the insurers noted above to set up an onsite review or to have specific elements of the member’s medical records faxed or mailed for review.

Highmark says that this year’s measurements are:

  • Adult body mass index (BMI) assessment
  • Weight assessment and counseling for nutrition and physical activity for children and adolescents
  • Childhood immunization status
  • Immunizations for adolescents
  • Lead screening in children
  • Cervical cancer screening
  • Colorectal cancer screening
  • Controlling high blood pressure
  • Comprehensive diabetes care
  • Medication reconciliation post-discharge
  • Transitions of care
  • Prenatal and postpartum care
  • Well-child visits for the first 15 months of life, 3-6 years, and adolescent well-care visits

Access Highmark’s HEDIS Measures Reference Guide.

Questions regarding the HEDIS report can be directed to these Highmark representatives: Anne Strout at (412) 544-4592 or Joan Zalewski at (412) 544-2696.

For additional details, visit Highmark’s NaviNet Plan Central page online.

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