HEDIS^® Medical Record Reviews

Blue Cross and Blue Shield of Nebraska (BCBSNE) requests medical record data at certain times of the year for quality improvement initiatives. Medical record reviews may require data collection on services obtained over multiple years. Archived medical records/data may be required to complete data collection.  

For our reviews, we look for details that may not have been captured in claims data such as blood pressure readings, HbA1c lab results and colorectal cancer screenings. This information helps us enhance our member quality improvement initiatives and reporting to government agencies such as CMS.  

A BCBSNE employee or designated vendor(s) will initiate the medical record request(s). Provider offices are responsible for providing the documentation requested in a timely manner. BCBSNE or its designated vendor(s) will contact your office to establish a date for an onsite visit or the option to fax or mail the data requested. A patient list will be sent including the name and information being requested. If your office is selected for an onsite visit, please have the medical records available ahead of time. If a requested medical record is not available at your practice, please notify the BCBSNE employee or the designated vendor immediately.  

We request that providers allow BCBSNE employees or its designated vendor(s) to scan the medical records during an onsite visit. The National Committee for Quality Assurance (NCQA) requires proof of service for any data that is collected from a medical record. As a participating provider, you have agreed to provide copies of medical records at no cost to the Plan. Please refer to your provider agreement or reach out to us if you have any questions.