February 2021
BCBSIL Medical Record Retrieval Summary
Blue Cross and Blue Shield of Illinois (BCBSIL) or a contracted vendor may be contacting you in the coming months for patient medical records for different audits, Healthcare Effectiveness Data and Information Set (HEDIS®) data collections or other programs. To help you keep track of the initiatives and vendors, we’ve summarized the information below:
| Record Collection Dates | Name of Initiative | Member Type | Vendor or BCBSIL | ||||||
| Through April 2021 | Medicaid HEDIS Medical Record Data Collection | Medicaid | Change Healthcare and BCBSIL | ||||||
| Through April 2021 | Medicare Advantage HEDIS Medical Record Data Collection | Medicare Advantage | Change Healthcare and BCBSIL | ||||||
| Through April 2021 | HEDIS Medical Record Data Collection | Commercial and Retail PPO and HMO | BCBSIL | ||||||
| Through April 2021 | Federal Employee Program® (FEP®) HEDIS Medical Record Data Collection | FEP | Change Healthcare and BCBSIL FEP staff | ||||||
| January – September 2021 | 2019 Health and Human Services Risk Adjustment Data Validation (HHS-RADV)/Initial Validation Audit (IVA) | ACA-compliant individual and small group plans | BCBSIL | ||||||
| May 2021 – January 2022 | 2020 HHS-RADV/IVA | ACA-compliant individual and small group plans | BCBSIL | ||||||
| June – December 2021 | Quality Improvement (QI) Project | HMO | BCBSIL | ||||||
Patient authorization for release of medical record data is not required. These reporting activities are considered health care operations under the Health Information Portability and Accountability Act (HIPAA) of 1996 and its implementing regulations (45 C.F.R. Parts 160 and 164), and the Health Information Technology for Economic and Clinical Health (HITECH) Act, as incorporated in the American Recovery and Reinvestment Act (ARRA) of 2009, and its implementing regulations, each as issued and amended.
We appreciate your time and continued collaboration. If you have any questions about medical record requests, please contact your assigned Provider Network Consultant (PNC).
HEDIS is a registered trademark of NCQA.
Change Healthcare is an independent third party vendor that is solely responsible for the products or services they offer. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendor. If you have any questions regarding the services they offer, you should contact the vendor directly.