Date Issued: 7/28/2015
Each year, EmblemHealth requests that you submit medical records to confirm that our members received the appropriate preventive and chronic care services from you.
This information, required by New York State Law, is then compiled by NCQA, CMS and the NYSDOH into usable, publicly available consumer guides that help your patients select a plan that is right for them. This data includes HEDIS® (Healthcare Effectiveness Data Information Set), CMS Star Ratings and NYS QARR (Quality Assurance Reporting Requirements).
Please make sure that your notations about member care, including patient counseling, screenings and assessments (i.e. pain, depression, activities of daily living [ADLs] are legible, well documented, dated and signed in the medical record. This earns the highest HEDIS®, CMS Star Ratings and NYS QARR (Quality Assurance Reporting Requirements) scores.*
If we request a large number of medical records from your practice, please consider one or more of the following options:
- Provide remote access for your EMRs.
- Allow an EmblemHealth staff member to come on site to access and review/copy records.
- eFax requested medical records to 1-212-510-5953.
- Email requested medical records to HedisRecords@emblemhealth.com.
- Contact your HEDIS team contact Brian Galli at 1-631-844-2584 or firstname.lastname@example.org to set up an FTP site or shared drive access. (Implementation of this option must be done early because it takes a few weeks to set up.)
- For groups utilizing paper records, we may offer UPS service as an alternative to faxing or on-site review.
Throughout the year, we can accept targeted information from your EMR. Please include all the fields as indicated on these sample templates (Medical and Laboratory claims) to create your Personalized Excel Spreadsheet. Send your information to our Quality Management (QM) team at email@example.com. Please note: NYS and CMS require that certain medical records undergo audit by a certified auditor. In these cases, EmblemHealth will need to request a copy of your medical record.
* A list of the Measures for 2015 is available in our Provider Toolkit.