AmeriHealth Caritas Ohio - Annual HEDIS Quality Project FAQ

Dear Office Manager/Medical Records:


The annual Healthcare Effectiveness Data and Information Set (HEDIS®) reporting period is just around the corner, and I am writing to request your cooperation with our efforts to collect medical record data for our members whom you have treated.


AmeriHealth Caritas Ohio continues our collaboration with Inovalon, which is now operating as ComplexCare Solutions. ComplexCare Solutions will manage the medical record retrieval for the annual medical record review process. ComplexCare Solutions is required to comply with Health Insurance Portability and Accountability Act (HIPAA) Privacy requirements throughout the retrieval process and is trained in medical record retrieval for HEDIS, Centers for Medicare & Medicaid Services (CMS), and state quality reporting programs. Disclosure and use of the medical records, and the collection of medical records for this purpose, is considered to be treatment, payment, or health care operations under HIPAA regulations (45 C.F.R. 164.502(a)(1)(ii)).


We appreciate your cooperation in working with ComplexCare Solutions to schedule retrieval of any requested member records. We remind you that, under the terms of your provider agreement, records are to be provided at no charge.


Click here to read the HEDIS Medical Record Retrieval Project FAQs in the provider portal.


If you have any questions, please reach out to Grace Robles, Lead HEDIS Data Reviewer of MRR Operations at 215-937-8372. We greatly appreciate your cooperation and timely assistance with this medical record request.




Jhera L. Woodard
Director, Quality Management
AmeriHealth Caritas Ohio

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