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Highmark Now Performing Annual HEDIS Medical Record Reviews

Staff from Highmark who are trained as registered nurses are conducting the annual Healthcare Effectiveness Data and Information Set (HEDISĀ®) medical record reviews from February through mid-May 2018. The reviews will be based on measurement year 2017 data.

The HEDIS report includes the medical record review for the assessment of compliance with a set of standardized performance measurements that health plans report on to the National Committee for Quality Assurance. The HEDIS data are collected and reported on an annual basis as part of Highmark's accrediting and governmental requirements.

The measurements this year are:

  • Adult body mass index (BMI) assessment
  • Weight assessment and counseling for nutrition and physical activity for children and adolescents
  • Childhood immunization status
  • Immunizations for adolescents
  • Lead screening in children
  • Cervical cancer screening
  • Colorectal cancer screening
  • Controlling high blood pressure
  • Comprehensive diabetes care
  • Medication reconciliation post-discharge
  • Transitions of care
  • Prenatal and postpartum care
  • Well-child visits for the first 15 months of life, 3-6 years, and adolescent well-care visits

A random sample of members will be identified, and a representative from Highmark will notify you either by telephone or fax to set up an onsite review or to have specific elements of the member’s medical records faxed or mailed to Highmark for review.

For more information regarding HEDIS measures, please review the HEDIS Measures Reference Guide .

If you have any questions regarding the HEDIS report, please contact one of the following representatives from Highmark’s Clinical Service area: Anne Strout at 412-544-4592 or Joan Zalewski at 412-544-2696.

 

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