Blue Review
A newsletter for contracting institutional and professional providers

January 2019

Close HEDIS® Gaps Easily Through the Availity® Provider Portal

You may now quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS) measures using Availity’s new Clinical Quality Validation (CQV). CQV will allow providers to electronically document their patient’s care and assessments to close quality HEDIS gaps for Blue Cross and Blue Shield of Illinois (BCBSIL) members. Additionally, CQV helps support BCBSIL’s Centers for Medicare & Medicaid Services (CMS) star rating for HMO and PPO Blue Cross Medicare AdvantageSM plans.

This new validation process will also verify that the data submitted by the provider is supported in the medical record.

CQV Functionality:

  • Captures quality-related medical documentation to close quality HEDIS gaps
  • Ensures quality measures documented in medical records are captured accurately for submission to CMS for HEDIS Stars ratings
  • Will display care gaps that BCBSIL provides to Availity
  • Provides alerts of care gaps, directing providers to access their work queue

Existing Availity users do not have to complete an additional registration to access CQV. However, Availity administrators need to ensure their users are assigned the Medical Staff and Office Staff roles.

CQV Benefits:

  • Improves engagement, health outcomes
  • Offers an easy, consistent completion process
  • Improves quality of information collected
  • Maintains document integrity and security
  • Reduces manual processes, decreases medical requests during HEDIS seasonal reporting

Learn More About CQV:

Note: This new feature is offered as an added service and does not replace manual processes currently in place.

Not yet registered with Availity? Visit availity.com to get started. If you need assistance, you may contact Availity Client Services at 800-282-4548.

To learn more about HEDIS, refer to the In-depth Look at HEDIS article published in the BCBSIL July Blue Review.