Each year, the National Committee for Quality Assurance (NCQA) measures the clinical quality performance of health plans across the nation. The assessment in the NCQA’s standardized measurement criteria — known as the Healthcare Effectiveness Data and Information Set (HEDIS) — includes considerations such as effectiveness of patient care, access to and availability of care, patient experience, and management of health conditions. The clinical components are measured using data from claims and medical record reviews.
In the next few weeks, you may receive a letter or a phone call from a Harvard Pilgrim representative requesting copies of medical records for specific patients related to the HEDIS project. We appreciate your assistance in providing us access to these records or in sending copies of the requested documentation to us for our review. You can be assured that our staff will maintain confidentiality of all medical information as required by HIPAA regulations. Your help is crucial to the project, as every medical record counts, and your prompt response will ensure that Harvard Pilgrim’s HEDIS measures accurately represent the high quality of care you provide to our members.
With this in mind, be sure to look out for the bright yellow HEDIS envelope in late January; if you have any questions about the HEDIS process, please call the HEDIS help line at 866-637-3337.