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Date: January 31, 2020
To: Health Plan of San Joaquin (HPSJ) Providers
From: Medical Management Department – Health Plan of San Joaquin
Subject: HEDIS: Annual Medical Records Review
Business: Medi-Cal, MCAP (Medi-Cal Access Program, previously known as AIM)

HPSJ Quality Management Department is preparing to launch the 2020 NCQA HEDIS Survey and Medical Record Review audit. Traditionally scheduled for February through the end of May of each year, the 2020 Medical Review Process will begin next week, February 10th.

What is HEDIS? – A Recap
The Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used array of performance measures in the United States health care delivery system. HEDIS was developed and is maintained by the National Committee for Quality Assurance (NCQA). The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking and diabetes. The State of California Department of Health Care Services (DHCS) uses the HEDIS measures to evaluate health issues and health plan performance.

The 2020 Medical Records Review
During the coming weeks, HPSJ will work with our contracted providers to review encounter and claims data from the prior year (2019) and in some cases up to five years (2015 – 2019) and conducts medical record reviews to survey “how well your practice” completes certain services.

The HEDIS-related services include:

  1. well child visits
  2. immunizations
  3. timely prenatal and postpartum visits
  4. diabetic care
  5. controlling high blood pressure
  6. cervical cancer screenings
  7. adult BMI
  8. weight assessment/counseling

HEDIS measures allow HPSJ to gauge the quality and effectiveness of care through patient record audits. At this time, we can identify any discrepancies and share those findings with your practice. Importantly, they also enable HPSJ to reward our providers for their efforts through our incentive program.

We thank you for your continued partnership in delivering the highest quality of preventive and effective care for our members who are your patients.

If you have any further questions, please contact our Customer Services Department at 209- 942-6300.

Posted on February 7th, 2020 and last modified on February 7th, 2020.