Each year, BCBSRI is required to participate in nationally recognized quality studies, called the Healthcare Effectiveness Data and Information Set (HEDIS). These performance measures are used by the National Committee for Quality Assurance, the Centers for Medicare & Medicaid Services, and the Rhode Island Department of Health to monitor the performance of health plans.

We understand that quality monitoring activities and the HEDIS data collection process create extra work for offices where medical records are randomly selected for review. The assistance and cooperation of our network physicians and providers is essential to obtain meaningful results, and we thank you in advance for your understanding.

One or more of your patients’ medical records may be selected for review. To help minimize the time required by your staff, BCBSRI will handle all record retrieval. Your office will be contacted to determine the retrieval method. Please contact our team if you have concerns about completing this request due to the demands of the pandemic.

Any information shared with BCBSRI during these audit activities and reviews will be kept in the strictest of confidence and in accordance with all applicable state and federal laws regarding confidentiality of patient records, including HIPAA. Disclosure of medical information to a health plan is permitted by a written consent signed by our members at the time of initial enrollment in the health plan. No special authorization is needed.

If you have questions or concerns regarding this audit, please contact us at (401) 459-2026 or you can email Laura.Raso@bcbsri.org. We appreciate your cooperation.