Healthcare Effectiveness Data and Information Set (HEDIS®) is a tool developed by NCQA that measures performance in the delivery of medical care and preventive health services. It provides a consistent way to evaluate the quality of care you provide to our members. BlueChoice® HealthPlan and BlueCross BlueShield use HEDIS to identify and acknowledge areas of excellence and opportunities for improvement.
In order to comply with HEDIS requirements, we may request discharge summaries from facilities for our members within 24 hours of discharge. Discharge summaries are an important part of care coordination and also allow us the opportunity to evaluate members’ medical needs post discharge.
A complete discharge summary should include:
- The member’s name
- The member’s date of birth
- The admission and discharge dates
- Medications at discharge
- A follow up appointment(s) and reconcile the discharge location (e.g., skilled nursing facility or home health)
- The discharge notes (optional)
What you need to do:
We recommend when BlueCross members arrive at your office or facility, continue to ask to see their current member ID cards at each visit. Doing so will help you:
- Identify the member's product.
- Obtain health plan contact information.
- Speed clams processing.
Notes must be filed in the outpatient medical record within the 30 day window
There must be proof of this via a date and time stamp from a fax ticker-tape, auto date and time stamp from an electronic medical record (EMR) when scanned into the record, or if an integrated EMR proof that it was available in the outpatient record within the 30 day window.
Discharge summaries should include a detailed account of the patients’ treatment by the provider and plan of treatment.
If you receive requests for discharge summaries, please ensure the summaries are complete and contain the information outlined. Please respond to requests as soon as possible.
If you have questions about this bulletin please contact Provider Relations and Education by submitting the Provider Education Contact Form or by calling 803-264-4730 and a knowledgeable education specialist will respond.