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Upcoming HEDIS® Medical Record Review for Out-of-Area Members

Audience: Professional Providers

We are providing advance notice of an upcoming medical record retrieval initiative in support of the Healthcare Effectiveness Data and Information Set (HEDIS®).

To assist with this effort, we have engaged an independent company, Inovalon, Inc. (Inovalon), to collect medical records on our behalf for members who are outside of the Excellus BlueCross BlueShield service area.

Inovalon’s medical record collection efforts will take place from February 10 – April 29, 2022.  Please keep this information on hand so that you are prepared if Inovalon contacts you regarding its record retrieval efforts on our behalf.

An Inovalon representative will work with your office to obtain copies of records in a manner that is the most convenient for you. 

Please note that Inovalon is bound by the terms and conditions of a business associate agreement executed with Excellus BCBS. Appropriate safeguards are in place to ensure full compliance with all defined privacy and security provisions. Your participation agreement with Excellus BCBS supports the request for medical records.

One of the ways we measure the success of our shared continuity of care and overall quality goals is through analysis of the data we collect annually in our HEDIS review. Thank you for your cooperation and collaboration with this important work.

In accordance with 45 CFR § 164.506(c) (4), medical providers are permitted, when appropriate, to disclose patient medical information without authorization from the patient. To the extent that New York state patient consent requirements are more strict than those found in the Health Insurance Portability and Accountability Act’s (“HIPAA”) Privacy Rule, most, if not all, participating provider agreements with our health plan require providers to obtain patient authorizations or consents from our members directly. If execution of written patient authorizations or consents for release of patient records to Excellus BCBS as permitted by HIPAA is not a routine part of your practice, we encourage you to incorporate this measure as required under the terms of your Participating Provider Agreement.

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