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Our Quality Management department is preparing for its yearly medical record review for the Healthcare Effectiveness Data and Information Set (HEDIS®), Regulatory State Reporting, and the Centers for Medicare & Medicaid Services (CMS). In the next couple of weeks, you may receive a letter containing a list of your patients for whom we need medical records and a HEDIS Medical Record tip sheet. We ask that you send us back the patient list and the section of the patient chart that shows the HEDIS measure has been met. The return fax number and secure email instructions will be noted in the letter.
This project involves collecting information from medical records and submitting the findings to the state and the National Committee for Quality Assurance (NCQA). Compliance with HEDIS data collection is part of your Participating Provider Agreement(s). HEDIS and CMS consider missing records as noncompliant.
NOTE: If you use outside vendors to collect medical records, it is your contractual obligation to make members’ medical records available to the plan – at no charge – for these reviews.
We appreciate your cooperation and thank you in advance for your prompt response. If you have any questions or concerns, call our HEDIS Helpline at 631-844-2420.
We know that some of our providers or their office staff are being asked to authenticate their identity more often than expected when signing in to the provider portal. The portal is set up to ensure that our members’ privacy is protected and your administrative burden is minimal.
The portal requires authentication every time you sign in unless you check the box for us to remember you and delay the next authentication for 30 days. If you’ve checked the box and you are still being asked to authenticate, these are some of the reasons why:
- Signing in from a different computer or browser.
- Sharing your computer and browser with others.
- Clearing your browsing history or cache.
- Using Chrome with the sync feature set to on.
You need to consistently use a dedicated computer and browser for the 30-day delay to work.
Thank you for cooperating with our security practices and protecting patient data.
MD Perspectives
Hello, colleagues.
Addressing social determinants of health (SDOH) is complex and needs a delicate approach. Given the complexity of the topic, we understand that practices cannot address everything. Even so, we should all start somewhere. See how we can help you.
Our three-pronged approach to SDOH is to listen to members by collecting information, identifying the barriers to good health, and proposing reliable solutions. See more on our SDOH three-pronged approach
Lama
Lama El Zein MD, MHA
Sr. Medical Director/Population Health
If there are other health topics you would like our perspectives on, please write to us at
emblemhealthmedicaldirectors@emblemhealth.com.
While we welcome your suggestions, we ask that you do not send protected health information (PHI) or patient-specific issues to this mailbox. This mailbox should not be used for Complaints, Grievances, Appeals, or Claims Inquiries. The Claim Inquiry and Message Center features in the Provider Portals (EmblemHealth | ConnectiCare) should be used for those issues.
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