Each year, the National Committee for Quality Assurance (NCQA) measures the clinical quality performance of health plans 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 the Centers for Medicare and Medicaid Services (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 2025. 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, 2025. For questions, contact the Provider Quality Performance HEDIS® Help Line at 888-766-9818, option 1, ext. 52809.
Tip sheets to guide you in data submission
We’ve developed tip sheets to aid you and your practice in satisfying HEDIS measures and providing data that accurately reflects your practice’s performance on these important quality metrics.
On our HEDIS tip sheet webpage, you’ll find more than 20 concise tip sheets, each of which offers insight into a specific HEDIS measure, best practices, and guidance on required documentation. Topics include prenatal and postpartum care, transitions of care, diabetes screening for patients on antipsychotics, follow up after emergency room visits for patients with high-risk chronic conditions, and statin therapy for patients with cardiovascular disease — as well as many others. To prepare for HEDIS data collection, we encourage you to review these tip sheets.
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).