February 1, 2018
From February through early May 2018, Verscend may contact you with a medical record retrieval request. Verscend is an independent company that provides medical record retrieval on behalf of Premera. This medical record retrieval and review is part of our data collection for the Clinical Effectiveness of Care Measures, part of the Healthcare Effectiveness Data Information Set called HEDIS® (HEDIS).
What is HEDIS?
HEDIS is a set of quality measures used by more than 90 percent of U.S. health plans to assess performance on important dimensions of quality and service. The goal is to improve the quality of care for patients.
How is Premera involved?
Medical records from our members’ providers are required to compile the necessary data for some HEDIS measures. The Affordable Care Act also mandates that health plan providers report HEDIS measures to participate in state healthcare exchanges.
What to expect
Medical records for one or more of your patients may be identified for review during those months, and if so, Verscend may contact you. You can submit records through a secure online upload, fax, or mail. When the Verscend team sends you a request for medical records, they will include instructions for submitting the records. Verscend will contact if you if the records you submit are incomplete, illegible, or otherwise unclear.
Member authorization consent
Any information shared during medical record review activities is confidential, in accordance with all applicable state and federal laws, and Health Insurance Portability and Accountability Act (HIPAA) requirements regarding patient confidentiality. Note that patient-authorized information releases aren’t required in order for you to comply with this medical records request.
For more information about HEDIS and HIPPA guidelines, visit our web page. If you have further questions about HEDIS, contact your network contract specialist, or the Premera Provider Relations Department at Provider.relationswest@premera.com.