HNE will begin conducting HEDIS reviews on randomly selected medical records in March 2008.

Medical record reviews are a required component of the HEDIS process. These abstractions supplement data collected from our administrative/claims systems ensuring that complete and accurate information is reported. More importantly, these reviews allow us to gather data on where to direct health improvement activities..

HNE access to a member’s medical record is allowed through:

• Provider agreements permit inspection, audit and duplication of data and other records.
• A routine consent signed by members provides for use and disclosure of health records including authorization for information related to medical history and exams, services rendered, treatment given, coordination of care and quality assessment and measurement, including member surveys.
• The HIPAA Privacy Rule builds on customary health practices and quality assessment and improvement activities (such as HEDIS chart reviews) are specifically mentioned in the regulations under the definition of allowable health care operations (164.501 Definition of Health Care Operations).

Your cooperation with this process is critical to showing compliance in our practices and is ultimately a significant benefit to our members.  If your office receives a request to provide information, please respond no later than April 15, 2008.  This will allow HNE to meet regulatory quality reporting requirements.

For additional information, please contact Pat Scheer, HNE Director of Quality Operations at 413 - 233-3435 (email: PSCHEER@hne.com).

Note: To lessen the administrative burden on your office begin using the CPT Category II Codes, refer to the article entitled CPT Category II Codes.