Back to Insights and Updates for ProvidersDecember 2023

HEDIS MY2023 medical record requests

All products

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 NCQA and CMS, Point32Health will send HEDIS MY2023 medical record requests via mail to providers for all Point32Health (Harvard Pilgrim and Tufts Health Plan) products beginning in February 2024. While this was historically done separately by Harvard Pilgrim and Tufts Health Plan, it has been unified under one integrated Point32Health process in the interest of delivering a more seamless provider experience.

Using a systematic process, NCQA selects a sample of providers to receive these requests. Providers should follow the submission instructions as outlined in the mailing.

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.

Providers must electronically submit the necessary information to the Provider Quality Performance Department via fax at 617-673-0754 or secure email at [email protected] by Feb. 28, 2024. For questions, contact the Provider Quality Performance HEDIS® Help Line at 888-766-9818, option 1, ext. 52809.

On Point32Health’s HEDIS Tip Sheets for Your Practice page, you can find tip sheets we’ve developed to offer insight into specific measures and aid your practice in optimizing performance, including our newest two offerings related to the Adult Immunization Status (AIS–E) and Colorectal Cancer Screening (COL) measures. You’ll also find this tip sheet presentation providing information pertaining to HEDIS hybrid measures that require medical record review each year.

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.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Ryan Francis, Stephen Wong,

Kristin Edmonston,
Production Coordinator

Kristina Cicelova,
Graphic Designer