In January 2018, Independence will send letters to some provider offices to
advise that they may be selected to participate in an upcoming medical record
review required by the National Committee for Quality Assurance (NCQA).
Independence will review the medical records of some members during the first
half of 2018 regarding services received. Independence is required to undertake
this review to comply with regulatory and accreditation requirements.
Once provider offices have been selected, Independence will contact each
office to schedule an appointment for an on-site review from a nurse who is
trained in analyzing medical records. We will review the records in accordance
with the quality standards set by NCQA in its performance measurement tool
known as the Healthcare Effectiveness Data Information Set (HEDIS?).
Note: According to your Provider Agreement with Independence, if your
office is selected for this review, participation is mandatory.
If you have any questions regarding this upcoming NCQA-required medical
record review, please contact the Quality and Risk Management Department at
215-241-2678.
HEDIS is a registered trademark of the National Committee
for Quality Assurance (NCQA). Used with permission.