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Aetna® 2020 HEDIS® data collection is underway


Our staff or our contracted representatives (CIOX, Verscend) will soon contact your office to collect medical record information on behalf of our members. We appreciate your understanding and cooperation as we complete required quality reporting with minimal disruption to your practice. 


Why is this necessary?

Healthcare Effectiveness Data and Information Set (HEDIS1) data collection is a nationwide, joint effort among employers, health plans and physicians. The goal is to monitor and compare health plan performance as the National Committee for Quality Assurance (NCQA) specifies. 


We must regularly send health care quality data to The Centers for Medicare & Medicaid Services (CMS) for our Aetna and Coventry Medicare Advantage organizations. We collect most of the data from claims and encounters. We also gather data on services provided and member health status from member medical records. 


What we may need from you

If we contact you, please cooperate with our request for timely access to our members' medical records. Our representatives will work with you and give you options for sending medical records. 


Meeting HIPAA guidelines

Our representatives serve us in a role that the Health Insurance Portability and Accountability Act (HIPAA) defines and covers. According to the HIPAA, Aetna is a “Covered Entity,” and our representative's role is as a “Business Associate” of a “Covered Entity.” Giving medical record information to us or our representatives meets HIPAA regulations. 


We appreciate your help in our data collection efforts. 


1HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)