Feb 1, 2024

2024 mandatory HEDIS® audit

Each year, BCBSRI is required to participate in nationally recognized quality studies, called the Healthcare Effectiveness Data and Information Set (HEDIS®). These performance measures are used by the National Committee for Quality Assurance (NCQA), the Center for Medicare and Medicaid Services (CMS), and the Rhode Island Department of Health (RIDOH) to monitor the performance of health plans.

We understand that quality monitoring activities and the HEDIS data collection process create extra work for offices where medical records are randomly selected for review. Your assistance and cooperation are essential to obtain meaningful results, and we thank you in advance for your understanding. 

One or more of your patients’ medical records may be selected for review. To minimize the time required by your staff, BCBSRI will undergo a record retrieval process. BCBSRI will be contacting practices over the next several months to obtain the selected medical records for review.

Any information shared with BCBSRI during these audit activities and reviews will be kept in the strictest of confidence and in accordance with all applicable state and federal laws regarding confidentiality of patient records, including HIPAA. Disclosure of medical information to health plans is permitted by a written consent signed by our members at the time of initial enrollment in the health plan. No special authorization is needed. 

If you have questions or concerns regarding this audit, please contact Senior Quality Management Analyst Laura Raso at (401) 459-5989 or Laura.Raso@bcbsri.org.