Annual HEDIS® Medica Record Review Underway

The annual Healthcare Effectiveness Data and Information Set (HEDIS®) Medical Record Review is being conducted now through May 2023.

This review assesses Highmark’s contracted provider compliance with a set of standardized performance measurements that Highmark is required to report to the National Committee for Quality Assurance (NCQA). HEDIS data is collected and reported on an annual basis as part of Highmark's accrediting and governmental requirements.

The measurements this year are:

  • Controlling High Blood Pressure
  • Colorectal Cancer Screening
  • Hemoglobin A1c Control for Patients with Diabetes
  • Blood Pressure Control for Patients with Diabetes
  • Eye Exam for Patients with Diabetes
  • Transitions of Care
  • Cervical Cancer Screening
  • Childhood Immunization Status
  • Immunizations for Adolescents
  • Lead Screening in Children
  • Prenatal and Postpartum Care
  • Weight Assessment and Counseling for Nutrition and Counseling for Physical Activity for Children and Adolescents

For information on who will be conducting this year’s review, who to contact with your questions, or what the COVID-19 procedures are, please review the recently published Plan Central Message: Annual HEDIS® Medical Record Reviews to Begin in February 2023.

To access it, log on to NaviNet® and click on Resource Center from the blue left-hand menu. Once you are redirected to the Provider Resource Center, go to the Plan Central Library which can be found under NEWSLETTERS/NOTICES on the left menu.

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