HEDIS/QARR Medical Record Review and Clinical Data Collection

EmblemHealth’s Quality Management (QM) department performs annual medical record data collections for HEDIS® (Healthcare Effectiveness Data and Information Set) and QARR (New York State Department of Health Quality Assurance Reporting Requirements).

HEDIS and QARR measure the performance of health plans and their participating practitioners on important aspects of preventive, acute and chronic health care. HEDIS and QARR data are used by insurance purchasers and consumers as well as regulatory and accreditation agencies.

As an EmblemHealth, GHI, HIP or Vytra network provider, you may be contacted to supply medical records for HEDIS/QARR reporting. If contacted, please take the time to find the requested member records and provide them to the QM department for our review. Please note: HEDIS and QARR scoring methodology considers a missing record to be non-compliant, and we will not receive credit for the service.

New York State Law requires that EmblemHealth and its network physicians comply with HEDIS and QARR initiatives, and that we report the results to the State. The US Department of Health and Human Services has stated that supplying the requested records to us for HEDIS/QARR reporting does not violate the HIPAA Privacy Rule. See 45 CFR 164.506(c) (4).

Your cooperation in completing any requested medical record reviews will help us communicate to the medical and consumer community that we are committed to meeting the highest standards of care.

Together, we can place EmblemHealth and you - our network practitioner community - in the 90th percentile in the nation for all measures!


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