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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

January 2019

HEDIS 2019 Coming Soon: Your Cooperation is Crucial

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.

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Network Matters Archives

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HPHConnect for Providers Getting a New Look in 2019

2019 Quality Grant Applications Due by Feb. 15

HEDIS 2019 Coming Soon: Your Cooperation is Crucial

HPI to Administer BMC HealthNet Plan

Behavioral Health: Services for Improved Access


New Opioid Safety Edits for 2019 Medicare Advantage Plans

Medical Policy Update: Tumor Treating Fields

Reminder: Formulas and Enteral Nutrition Require Prior Authorization

Updates to Proton Beam Therapy Medical Policy

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Pharmacy and Therapeutics Committee Meeting Update


Coding Program Launching in January for Medicare Advantage


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Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator