HEDIS and risk adjustment - Provider Newsletter February 2025

BLUECONNECT

Providers

February 2025

In This Issue

►	February News: Executive Summary

►	Medicare Advantage Plans - Info

►	Remits on Availity provider portal

►	HEDIS reporting overview for 2025

►	April 1: Quarterly drug fee schedule updates

►	2025 Prefix Replacement Tips

►	SNF Quick Transfer Program

HEDIS and risk adjustment: 2025 records requests

AZ Blue uses the Health Effectiveness Data and Information Set (HEDIS) to stay on track with member healthcare quality. To comply with HEDIS, risk adjustment, and other government requirements, we reach out to providers throughout the year to gather member information from medical records. This helps ensure accurate reporting, appropriate risk scores, and a consistent level of care for our members.

Your support matters

To help promote quality care, we ask that you follow these guidelines:

•

Get familiar with the HEDIS performance measures relevant to your practice and make sure your clinical and claims teams know what needs to be reported on your claims.

•

Consistently use clinical and operational protocols that align with the HEDIS standards of care.

✓

Encourage patients to get general preventive care, screenings, and flu shots.

✓

Talk to patients who smoke about tobacco cessation strategies.

•

Integrate CPT^® Category II codes into your system and use them on your claims.

•

Code your claims with complete, accurate, and clinically appropriate data to reflect member health status.

•

Respond timely to medical records requests for HEDIS and risk adjustment tracking.

Please note that AZ Blue (and delegated entities and vendors) generally do not reimburse providers or vendors for charges to copy records.

2025 HEDIS and risk adjustment records requests

You may already have received requests from our delegated vendors for the 2025 measurement year. Here is an overview of our HEDIS and risk adjustment records request time frames.

RECORDS REQUESTER

TIME PERIOD

LINES OF BUSINESS

Guardian Angel Consulting
(contracted with AZ Blue)

February through May

Commercial plans
ACA (Exchange) plans
Medicare Advantage plans

Reveleer
(contracted with the BCBS Association)

February through May

Federal Employee Program^® (FEP^®) plans

Virtix Health
(contracted with the BCBS Association for out-of-state member records)

January 2025 through January 2026

BlueCard^® out-of-area plans

AZ Blue

June 2025 through January 2026

Commercial plans
ACA (Exchange) plans
Medicare Advantage plans
Federal Employee Program (FEP) plans

Note: Because delegated entities and vendors agree to preserve the confidentiality of members’ protected health information (PHI), you are permitted to comply with their medical records requests without authorization from patients (BCBS members).

More information

To learn more about HEDIS, you can visit the NCQA website: ncqa.org/HEDIS. To better understand risk adjustment, see the CMS risk adjustment page. For more information about AZ Blue’s request processes, check out our Records Requests guidelines.

Thank you for your support in delivering quality care to our members.

In This Issue

►	February News: Executive Summary

►	Medicare Advantage Plans - Info

►	Remits on Availity provider portal

►	HEDIS reporting overview for 2025

►	April 1: Quarterly drug fee schedule updates

►	2025 Prefix Replacement Tips

►	SNF Quick Transfer Program

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

CPT® (Current Procedural Terminology) codes are © 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Blue Cross, Blue Shield, the Cross and Shield Symbols, BlueCard, Federal Employee Program, and FEP are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

Reveleer is a registered trademark of Health Data Vision, Inc.

© 2025 Blue Cross Blue Shield of Arizona, Inc. All rights reserved.

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