HEDIS data collection preferences form

Help us streamline data collection from you

HEDIS data collection will not begin until February 2017, but we'd like to cause you as little disruption as possible should your patients be randomly selected for the audit.

Please complete this form once for each organization NPI/location to let us know the best way to gather information from your medical records system, and which provider records to access at that location.
OR
Complete this form once and email us a list of the organization NPIs with associated providers and provider NPIs by logging in to your Priority Health account to use your Secure Mailbox. Select HEDIS/Clinical analytics for the "To" address.

Should you have any questions about HEDIS, call Megan Reed, clinical analytics at Priority Health, at 616.464.8064 or email Megan.Reed@priorityhealth.com.

1. If the fax you received from us referenced a practice site ID number, enter it here: This question requires a valid number format.

2. Your office, location and contact information *This question is required.

Office Name

Organization/group NPI number This question requires a valid number format.

Office Contact First Name

Last Name

Office Contact Phone (numbers only, no dashes)

Office Contact Email Address This question requires a valid email address.

Record Location Address

Record Location Address 2 (enter NA if not applicable)

City

State

ZIP

Record Location Phone (numbers only, no dashes) This question requires a valid number format.

Record Location Fax (numbers only, no dashes) This question requires a valid number format.

3. Data collection method(s)
How do you want Priority Health to retrieve your medical records, should your patients be selected in the random HEDIS sample? *This question is required.

4. Vendor name (Cerner, EPIC, etc.)

4. What other method would you like us to use to collect the charts?

4. Do you have any restrictions on scanning, copying, printing, supplies, clearances? (We do bring our own supplies and any equipment needed.)

4. Do you use a copy service you'd like us to be aware of? If yes, please provide name/phone:

5. Provider NPI numbers
List the provider NPI numbers (separated by commas, with or without spaces) whose patient charts can be accessed through the method you selected at the location above.
OR
Type in "Will forward through Secure Mailbox." Then log in to your account at priorityhealth.com and use your Secure Mailbox to email us. Select HEDIS/Clinical analytics for the "To" address. Attach your list of locations, each with your list of provider NPIs at that location. *This question is required.