Provider Alert! Annual HEDIS ® Medical Record Review Process to Begin in February

Date: January 26, 2021
Attention: Primary Care Providers

Review Period: February through May 2021

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: TCHP would like to inform network providers that the HEDIS® medical record data review process will begin in early February 2021 and proceed through early May 2021. Additionally, we have contracted with Inovalon, Inc. to retrieve medical records and perform HEDIS® medical record data abstraction on our behalf.  Please note the following:

• Inovalon serves as TCHP’s Business Associate as that terms is defined by the Health Insurance Portability and Accountability Act (HIPAA).
• Inovalon is ethically and legally bound to protect, preserve and maintain the confidentiality of any Protected Health Information (PHI) it gleans from clinical records provided by medical practice locations pursuant to its contractual obligations to TCHP.
• PHI that is used or disclosed for purposes of treatment, payment or health care operations is permitted by HIPAA and does not require consent or authorization from the member/patient.
• In this setting, please be assured that Inovalon will treat your patients’ PHI with the utmost protection and confidentiality.

How this impacts providers: Inovalon will contact your office to request copies of chart components to be sent via fax, mail, or through an electronic link (provided to the office upon request) for review. For any questions regarding the requested information or data collection process, please contact Inovalon at 1-844-682-9764. We encourage you to reply to any requests from Inovalon within 3 to 5 business days. A link to the medical record submission form is available here.
Inovalon is committed to the protection of all patient information and reminds providers to be diligent in following the specific Inovalon chart copying instructions such that accurate measure level patient information is provided while maintaining a minimum necessary patient information release approach.  Please note that TCHP generally does not reimburse for medical record copies requested for HEDIS® medical record collection.  For more information on reimbursement, please see your TCHP provider agreement or contact your TCHP Provider Relations Liaison.

Next steps for providers: Providers should inform their staff of this communication. Providers should contact their Provider Relations Liaison to address any questions or concerns about this process. Click here for a link to the contact information.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.