HEDIS MEDICAL RECORD REVIEWS

PROVIDING DETAILED REVIEWS AND REPORTS

Episource offers HEDIS performance-rating reports with in-depth reviews of eligibility, administrative claims, and encounter data.

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OVERVIEW

Improve your quality by partnering with Episource. We assist health plans during HEDIS season with medical record collection and abstraction for accurate reporting on HEDIS rates. Our abstraction team is comprised of RNs/LVNs, certified coders, and clinicians who are experienced in abstracting medical records for Medicare, Medicaid, GPRO, and Commercial HEDIS measures. Benefit from robust reporting and analytics tools designed to evaluate your performance with different quality measures for Medicare, Medicaid, ACO, and Commercial lines of business.

Our Quality Platform delivers interactive dashboards and reports that assist you in quickly identifying trends in performance. Utilize this data to advance the quality of care your patients receive, thereby improving your quality ratings. These reports detail year-over-year trends, as well as comparisons to industry benchmarks, to help you classify which measures need immediate action for the coming year. The reports can be viewed at multiple levels (e.g., Plan, medical group, clinic, provider).

We have designed this platform to help improve your HEDIS compliance rates to meet your goals. Benefit from report rates at the provider level to provide them with actionable Gaps in Care reports that can be used to call members for needed services.

BENEFITS

Weekly updates on abstraction and over-read status

Status reports (e.g. hybrid compliance rates by numerator; number of completed records by compliance status, pending records, records in progress, exclusions by measure)

Review of critical records/questions that require auditor feedback

Discussion with technical experts to formulate questions for the auditor on records that can be potentially considered as compliant

Ad hoc meetings to address any issues that come up during the HEDIS season

Experience with all CMS and State-required measures

Work with auditors to resolve issues on any records to maximize HEDIS rates

Vigorous primary, secondary, and tertiary pursuits processes to maximize HEDIS rates

KEY FEATURES

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