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Published Date: 2025-01-21

Annual HEDIS® Medical Record Review Now Underway

The annual Healthcare Effectiveness Data and Information Set (HEDIS®) Medical Record Review is being conducted now through April 2025.

This review assesses provider compliance with a set of standardized performance measurements that we are required to report to the National Committee for Quality Assurance (NCQA). HEDIS data is collected and reported on an annual basis as part of our accrediting and governmental requirements.

The measurements being collected are:

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Childhood Immunization Status
Immunizations for Adolescents
Lead Screening in Children
Cervical Cancer Screening
Care for Older Adults
Controlling High Blood Pressure
Glycemic Status Assessment for Patients with Diabetes
Eye Exam for Patients with Diabetes
Blood Pressure Control for Patients with Diabetes
Transitions of Care
Prenatal and Postpartum Care

We appreciate your assistance with medical record collection and review and are happy to assist you in fulfilling this request any way we can. To best meet your needs, there are multiple options for submitting medical records, including secure fax, secure messaging through NaviNet, or an on-site review. A member of our retrieval staff will contact you to discuss your preference.

Please recall that, as outlined in the Participating Provider Agreement with Highmark Wholecare, providers must respond to requests for medical records in support of all state and regulatory-required activities, including the annual HEDIS medical record review project, within the requested timeframe and at no cost to Highmark Wholecare and its members. If you have questions or concerns about any portion of this process, please email the ClinicalQualitySupportTeam@highmarkwholecare.com or call 412-918-8981.

NaviNet^® is a separate company that provides an internet-based application for providers to streamline data exchanges between their offices and Highmark Wholecare such as routine eligibility, benefits and claims status inquiries.