Our Quality Management team is preparing to collect and review medical records for the annual Healthcare Effectiveness Data Set (HEDIS) medical record project for 2026.
This project supports HEDIS, the Centers for Medicare & Medicaid services (CMS), and New York State regulatory reporting. All information found within the medical record is abstracted, incorporated into our quality reporting, and submitted to National Committee for Quality Assurance (NCQA).
The project runs annually from January through April and is focused on a subset of measures that target care that may be difficult to capture through regular claims submissions. EmblemHealth does not partner with third party vendors for quality reporting. All medical record requests will come directly from the health plan.
HEDIS data collection compliance is included in all EmblemHealth provider participation agreements. Providers are required to supply charts without charging a fee.* If your group uses a vendor, please make sure they understand they must send the requested chart(s) in the stated time frame and that they may not ask to be paid for chart(s) submitted.
Regulatory agencies consider missing records as being noncompliant.
*Unless specifically provided for in your contract.
Here are some frequently asked questions about the annual HEDIS project:
What should your office expect?
- You will receive a notification in January that the record collection will begin in the coming weeks.
- You will receive a list of your patients who are EmblemHealth members with a corresponding list of measures they are included in.
- This notification will also include a measure guide stating what documentation is needed for each measure.
How can I send the records?
- Upload to provider portal.
- Secure fax number sent with the record request.
- Secure email: hedisrecords@emblemhealth.com
- Mail directly to Quality Department:
EmblemHealth
P.O. Box 5100
Kingston, NY 12402
Attn: Patricia Albert
- Remote access is accepted or permitted.
- Onsite collection is available if more than 10 patients’ records are requested.
What should I send back?
Every medical record submitted must have the patient’s first name, last name, and date of birth, in addition to the full member demographic page. It should also include a copy of the requested medical records that includes a demographic sheet with the patient’s name and date of birth.
If you are not sending records, please indicate the reason(s) why you are not submitting them. Your member list will have a check-off box and place to enter your reason(s).
How are we protecting patient privacy and securing medical data?
Data collection is permitted under the Health Insurance Portability and Accountability Act (HIPAA) legislation. The release of this information requires no special patient consent or authorization. Covered entities including health plans and providers are permitted to use and disclose protected health information (PHI) to conduct treatment, payment, or health care operation in accordance with the HIPAA privacy rule. Please note our staff have undergone extensive HIPAA training. This helps to ensure the privacy and security of your patients’ PHI.
Please send only the minimum amount of PHI needed to meet this request.
HEDIS data collection is a time-sensitive project. Medical records should be made available by the date requested.
Who can I ask if I have any other questions?
If you have HEDIS questions that are not covered above, send them to our Quality Department at hedishelp@emblemhealth.com for assistance.
Who do I let know that our HEDIS primary contact has changed?
Has your primary HEDIS contact information recently changed? If so, email hedishelp@emblemhealth.com with the update(s) so we can reach out to the correct person.