Monthly Care Opportunity Reports

Monthly Care Opportunity Reports

10/15/2019

We’re committed to quality care and service and fully support standards established by federal and state regulatory agencies, and accrediting bodies, including the National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data Information Set (HEDIS®).

We want to help you make sure your patients receive their recommended care including annual and periodic preventive screenings in a timely manner. In the coming weeks, you may begin receiving automated monthly care opportunity reports from Navigator@bcbssc.com. These reports show members attributed to your practice that are due for the care listed per NCQA and HEDIS® clinical measurement specifications. 

If the member already has the care opportunity completed, this is considered a gap in data. Please send medical records documenting the care given to HEDIS.Records@bcbssc.com. If the member has not had the care given, please contact the member to schedule the care. 

The reports also give an overall percentage of members' compliance and noncompliance by measure. This summary report will allow your practice to identify areas of possible improvement — either with additional care for members or increased coding specificity on claim submissions. If you have multiple locations, you will receive a master summary report enabling you to see how you are doing as an organization.

Better performance equates to less medical record requests, more incentive payouts with networks that offer them, and better performance in contractual programs, such as Rewarding Excellence and patient-centered medical homes (PCMH). 

Make sure emails from Navigator@bcbssc.com do not go to your spam folder, and direct any questions to Navigator@bcbssc.com.