Annual HEDIS Medical Record Review

Highmark Wholecare is conducting its annual HEDIS medical record review for Measurement Data Year 2025, starting in January, and continuing through April 2026. The National Committee for Quality Assurance (NCQA) requires this review to assess provider compliance with standardized performance measurements.

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, UPS, secure messaging via NaviNet, or an on-site review. Highmark Wholecare retrieval staff will contact providers to discuss their preferred submission method.

It is important to remember that, as per the Participating Provider Agreement, providers are obligated to respond to these medical record requests within the requested timeframe and at no cost to Highmark Wholecare or its members.

The HEDIS measurements are being collected to cover various areas that include:

• Weight Assessment and Counseling for Children/Adolescents
• Care for Older Adults
• Controlling High Blood Pressure
• Diabetes-related assessments (Glycemic Status and Blood Pressure Control)
• Transitions of Care
• Prenatal and Postpartum Care

For any questions or concerns about this process, providers can contact Leslie Riding at leslie.riding@highmark.com or by calling 412-918-8981.