2012 HEDIS reviews

Every year, Priority Health participates in the HEDIS^® (Healthcare Effectiveness Data and Information Set) methodology of collecting, measuring and reporting performance indicators. By doing so, Priority Health has the opportunity to measure the quality of care our members receive. In addition, we’re also able to compare ourselves with other exceptional plans throughout the country, share this information with the public, and identify areas for improvement within the plan.

HEDIS is the most widely used set of performance measures in the managed care industry and is developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS is part of an integrated system to establish accountability in managed care and contains 70 measures across eight domains of care.

By contract, all of our providers have agreed to participate in Quality Assurance reviews; HEDIS is considered one of those QA reviews. Again, per contract, we’ve agreed to provide you with 30 days advance notice of these reviews. This communication serves as that notice.

Priority Health HEDIS reviewers will visit provider offices during March, April and May to collect medical record data. Under HIPAA, HEDIS is an approved activity, as it is part of normal health care operations. We may conduct some reviews via fax to minimize interruptions to offices. If you would prefer to have a reviewer visit your office instead, let us know. Please welcome these reviewers into your office and assist them if they have questions. If you have questions about the process or the reviewers, please feel free to contact Gina Schutter at 616 464-8976.

Topics: HEDIS, Contracts