New Claims System Update

Provider Manual
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10 Medical Records

10.7 Quality Improvement and Reporting

Participation in quality improvement programs including HEDIS/5 STAR reporting is required of all providers, and it is important that you are aware that medical records will be requested from your office. Quality Metric abstraction will be performed on medical records to report HEDIS data to the health plan and CMS. Records may be used to evaluate additional resources or assist with predicative modeling to identify resources needed to improve patient wellbeing and quality of life.