HEDIS and QRS data collection are right around the corner

April 1, 2024

Each year, we collect data for the Healthcare Effectiveness Data and Information Set (HEDIS®).* The National Committee for Quality Assurance (NCQA), employers, and health plans developed HEDIS as an industry-wide method to help compare and assess a health plan’s performance in a variety of areas.

HEDIS, along with the Centers for Medicare & Medicaid Services (CMS) Quality Rating System (QRS) process for our customers with Marketplace plans, measures and reports clinical effectiveness results of our medical plans for significant public health issues such as cancer, heart disease, smoking, asthma, and diabetes.

What you need to know

  • Our initial requests for medical records are sent to provider offices beginning in late January.
  • The request includes a list of patients and a detailed description of what is needed from each medical record. The patients identified on each list are chosen through a random selection process.
  • The HEDIS medical record submission is time sensitive. Please return the requested medical records within the time frame noted on the request. We appreciate your timely response.
  • If you have an electronic medical record system, we can access the medical records remotely through our secure network, or you can upload the medical records directly to our secure file transfer protocol site. Electronic submission is a more efficient and reliable process that can minimize disruption to your office. You can also securely fax the requested documentation to us. However, we recommend sending no more than three medical records per fax to avoid transmission failure.

Please note that due to Health Information Portability and Accountability Act (HIPAA) concerns, we are not able to receive medical records by mail.

  • All protected health information is kept confidential, and only shared to the extent permitted by federal and state law. Data is aggregated to reflect just the presence or absence of a particular procedure at the health plan’s level.
  • HEDIS record collection is considered a health care operation under the HIPAA Privacy Rule, and patient authorization is not required.
  • Under your Cigna Healthcare provider agreement, you are required to cooperate with the HEDIS data collection process.

Shared administration

We provide health benefit services to individuals covered by Taft-Hartley and Federal Employee Health Benefit (FEHB) plans as part of our shared administration program. Please be aware that FEHB plans within the shared-administration product collect their own HEDIS data each year. These plans include:

  • American Postal Workers Union (APWU)
  • National Association of Letter Carriers (NALC)
  • SAMBA Federal Employee Benefit Association

Therefore, if you have patients who have Cigna Healthcare coverage through an FEHB plan, you may receive separate HEDIS requests directly from the administrators of those FEHB plans. Please follow their instructions to submit any required medical records.

For more information on HEDIS

Log in to the Cigna for Health Care Professionals website (CignaforHCP.com) > Resources > Medical Resources > Commitment to Quality > Quality > Healthcare Effectiveness Data and Information Set Record Collection.

Documentation tips are also available at CignaforHCP.com > Get Questions Answered: Resource > Medical Resources > Commitment to Quality > HEDIS Quick Reference Guides.

Please visit the NCQA website (NCQA.org) for more information on HEDIS.

* HEDIS is a registered trademark of NCQA.

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