Each year, the National Committee for Quality Assurance (NCQA) measures the clinical quality performance of health plans across the nation through a standardized set of quality measures. This measure set — known as the Healthcare Effectiveness Data and Information Set (HEDIS ®) — evaluates important dimensions of care and service including effectiveness of patient care, access and availability of care, patient experience, and management of health conditions. The clinical components are measured using data from claims and medical record reviews.
As required by the NCQA and CMS, Point32Health will send HEDIS MY2024 medical record requests via mail to providers for all Point32Health (Harvard Pilgrim and Tufts Health Plan) products beginning in February 2026.
Your help is crucial to the project, as every medical record counts, and your prompt response will ensure that Point32Health’s HEDIS measures accurately represent the high quality of care you provide to our members. You can be assured that our staff will maintain confidentiality of all medical information as required by HIPAA regulations. Please note that you may receive more than one mailing packet from us; we appreciate your cooperation in addressing all members and requests for medical records that you receive.
Point32Health requires providers to electronically submit the necessary information to the Provider Quality Performance Department via fax at 617-673-0754 or secure email at [email protected] by February 28, 2026. For questions, contact the Provider Quality Performance HEDIS® Help Line at 888-766-9818, option 1, ext. 52809. Point32Health values your continued participation with our clinical quality improvement efforts to meet regulatory and accreditation requirements for the NCQA and CMS HEDIS medical record review.
On Point32Health’s HEDIS and Star Rating tip sheets page, you can find a number of tip sheets we’ve developed to offer insight into specific measures and aid your practice in optimizing performance, including Prenatal and Postpartum (PPC) and Transition of Care (TRC) measures, as well as this tip sheet presentation providing information pertaining to HEDIS hybrid measures that require medical record review each year.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).