We’re streamlining medical record requests for closing gaps in care for HEDIS, star ratings and risk adjustment

A new Blue Cross and Blue Shield Association mandate will help streamline the medical record retrieval process for Blue Cross Medicare Advantage PPO patients nationwide.

Beginning Jan. 1, 2020, Blue Cross Blue Shield of Michigan will manage medical record retrievals for patients who are out-of-area MA PPO group members, in addition to Blue Cross members who live in Michigan. Out of area refers to patients who live in Michigan but are enrolled in another state’s Blue MA PPO plan.

We look forward to working with you and your practice to include this patient population in our current processes. The changes are expected to make the medical record request process simpler for you.

Going forward, health care providers will only receive medical record requests from Blue Cross Blue Shield of Michigan for these out-of-area Blue members. They won’t receive medical record requests from another state’s Blue MA PPO plan.

Blue Cross will work with providers to improve the care of out-of-area patients by:

• Supporting providers with additional information about any open gaps in care related to Medicare star ratings, HEDIS^® or risk adjustment.
• Requesting medical records to ensure Blue plans nationwide have a complete understanding of their members’ health status.

We’ll include more details about this process in a future issue of The Record.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance, or NCQA.