Annual HEDIS^® Medical Record Reviews to Begin This Month

Clinical staff from Highmark will conduct the annual Healthcare Effectiveness Data and Information Set (HEDIS^®) medical record reviews — based on measurement year 2025 data — from February through mid-May 2026.

The HEDIS report includes the medical record review to assess compliance with a set of standardized performance measurements that health plans report to the National Committee for Quality Assurance (NCQA). HEDIS data is collected and reported annually as part of Highmark's accrediting and governmental requirements.

The measurements being collected are:

• Blood Pressure Control for Patients with Diabetes
• Controlling High Blood Pressure
• Glycemic Status Assessment for Patients with Diabetes
• Lead Screening in Children
• Prenatal and Postpartum Care
• Transitions of Care
• Weight Assessment and Counseling for Nutrition and Counseling for Physical Activity for Children and Adolescents

Chart Retrieval Process

A random sample of members will be identified, and a Highmark representative will notify you either by telephone or fax to discuss the process to submit specific elements of the members’ medical records via fax or mail for review.

We are encouraging all providers to submit requested HEDIS medical records to Highmark via secure electronic delivery or fax to the designated return fax number identified on the original chart request.

If you have any questions regarding the HEDIS project, contact the following representative from Highmark’s Clinical Service area: Michael Clark-Polner at 412-544-7438.

Note: Continuity of Care documents (CCDs) are not an acceptable form of medical record documentation.

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