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HEDIS Hybrid Season Is Underway - Are You Ready?

Date: 02/13/18

HEDIS Hybrid Season kicked off this week. That means you may be receiving official medical records requests from Louisiana Healthcare Connections. To help you prepare, we’ve put this list of FAQs together:

What is HEDIS Hybrid Season?

HEDIS stands for Healthcare Effectiveness Data and Information Set. It’s the measurement tool used by health plans to evaluate performance in terms of clinical quality and member satisfaction. HEDIS is administered by the National Committee for Quality Assurance (NCQA).

HEDIS data is collected in three ways: administrative data is obtained from our claims database; survey data comes from member and provider surveys; and hybrid data comes from a combination of our administrative data and medical record reviews.

During HEDIS Hybrid Season, we send out medical records requests to our network providers to access member medical records for data that hasn’t been captured in claims.

What is Louisiana Healthcare Connections looking for in medical records?

By medical records, we mean the complete, comprehensive member records including X-rays, lab tests, results, examinations and notes. During HEDIS Hybrid Season, we look at a sample of medical records data. Hybrid data requires review of a random sample of these records to abstract data for services rendered that were not reported through claims/encounter data.

Measures typically requiring medical record review include comprehensive diabetes care, control of high blood pressure, immunizations, prenatal care and well child care. By analyzing this data, we can identify opportunities to help providers close gaps in care and improve outcomes for our members.

Tip: Learn more about our medical records requests in our comprehensive Provider Manual.

Is patient consent required?

No – patient consent or authorization is not required before submitting medical records for HEDIS Hybrid Season. HEDIS data collection and release of information is permitted under the HIPAA Privacy Rules (45 CFR 164.506). This is because the disclosure is part of quality improvement and assessment. All patient information is handled carefully with an ethical and legal focus on protecting, preserving and maintaining the highest standards of confidentiality. We are committed to partnering with our providers to ensuring that our members' information is kept secure and confidential!

What are the best practices for HEDIS Hybrid Season?

How does HEDIS data benefit providers?

Aggregated HEDIS rates are used to evaluate the effectiveness of our preventive health outreach. Physician-specific scores are used as evidence of preventive care from primary care office practices. These rates then serve as a basis for incentive programs. Our incentive programs reward our network providers for scoring well in quality indicators. 

Tip: Reach out to your dedicated Provider Consultant to learn more about our incentive programs! If you need help reaching your regional Provider Consultant, give our Provider Services team a call at 1-866-595-8133.

More Resources:

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