Close HEDIS^® Gaps easily through the Availity^® Provider Portal

Providers may now quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS) measures using Availity’s new Clinical Quality Validation (CQV). CQV will allow providers to electronically document their patient’s care and assessments to close quality HEDIS gaps for Blue Cross and Blue Shield of Texas (BCBSTX) members. Additionally, CQV helps support BCBSTX’s Centers for Medicare & Medicaid Services (CMS) star rating for Blue Cross Medicare Advantage (HMO)^SM and Blue Cross Medicare Advantage (PPO)^SM plans.

This new validation process will also verify that the data submitted by the provider is supported in the medical record.

CQV Functionality:

• Captures quality-related medical documentation to close quality HEDIS gaps
• Ensures quality measures documented in medical records are captured accurately for submission to CMS for HEDIS Stars ratings
• Will display care gaps that BCBSTX provides to Availity
• Provides alerts of care gaps, directing providers to access their work queue

Existing Availity users do not have to complete an additional registration to access CQV. However, Availity administrators need to ensure their users are assigned the Medical Staff and Office Staff roles.

CQV Benefits:

• Improved engagement, health outcomes
• Offers an easy, consistent completion process
• Improves quality of information collected
• Maintains document integrity and security
• Reduces manual processes, decreases medical requests during HEDIS seasonal reporting

Learn More About CQV:

• A CQV Tip Sheet is available on our Provider website for quick reference and navigational assistance.
• Refer to Availity’s Quick Start Guide for Clinical Quality Validation .
• Registered users may log on to the Availity Provider Portal for an on-demand webinar. Once you log on, select “Help & Training,” then “Get Trained” and search for the Clinical Quality Validation recording.

Note: This new feature is offered as an added service and may not completely replace manual processes such as in-person visits to request medical records.

Not yet registered with Availity? Visit availity.com to get started. If you need assistance, you may contact Availity Client Services at 800-282-4548.

At this time, electronic medical record request and submission process through CQV are only available for closing quality HEDIS care gaps and are not available for medical record requests resulting from utilization review activities or the claims adjudication process.

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

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.