As a provider in the Cigna network, your commitment to quality care greatly contributes to our customers care and satisfaction outcomes.

HEDIS and QRS – Measurements of Clinical Success

The National Committee for Quality Assurance (NCQA) ¹, employers, and health plans developed Healthcare Effectiveness Data and Information Set (HEDIS®)* as an industry-wide method to help compare and assess a health plan's performance in a variety of areas. HEDIS, along with the Centers of Medicare & Medicaid Services (CMS) Quality Rating System (QRS) for our Exchange customers, measures and reports clinical effectiveness results for our medical plans. HEDIS and QRS performance measures are related to many significant public health issues such as cancer, heart disease, smoking, asthma, and diabetes.

Cigna uses HEDIS/QRS measurement tools to evaluate performance in terms of clinical quality. Annually, we measure and report clinical effectiveness results for our medical plans and submit these results to NCQA/CMS to be included in developing national benchmark data. Our strong results demonstrate our success in supporting quality care for our customers.

With your help over the last several years, we have seen large increases in the number of customers having important preventive care screenings and doctor follow-up. With your continued help and the quality care you provide, we can continue to improve these percentages.

Clinical and Health Equity initiatives are actively pursued in order to promote improved health, well-being and peace of mind. Health Equity initiatives advance equity across race and ethnicity promoting positive interventions for food, housing, and transportation insecurities. Clinical and Health Equity initiatives include, but are not limited to, diabetes, asthma and hypertension management, breast, cervical and colon cancer screenings, childhood immunizations, depression, and alcohol and other drug use. We promote preventive care through telephone and digital outreach, web and social media campaigns, and mailings to people who are identified as potentially not having had recommended screenings, vaccines or physician follow ups. We partner with community organizations, providers and employers to offer incentives and education.

About our HEDIS record collection process

Each year, Cigna collects medical record data for HEDIS/QRS performance measures in accordance with NCQA/CMS specifications and reports those audited results to NCQA/CMS.

• Requests for medical record reviews are mailed to providers' offices in January and early February each year.
• The mailing includes a list of customers and a detailed description of what is needed from each patient's medical record. The customers identified on each list are chosen through a random selection process.
• The HEDIS/QRS medical record review is time-sensitive. The requested documentation should be returned within the time frame noted on the letter of request.
• The most efficient and secure way for Cigna to retrieve the requested medical record documentation is via access to a secure electronic medical record (EMR) system by Cigna staff through our secure network. Medical records may also be returned directly and securely by uploading to a Secure File Transfer Portal (SFTP). The other method to return requested medical records is via fax to Cigna's secure system.
  • A benefit to providing Cigna access to secure EMR systems includes increased safeguarding of protected health information (PHI) by decreasing risk to data being misdirected. Another benefit is the reduction of administrative burden to the providers' offices. Cigna staff will ensure compliance to the Health Information Portability and Accountability Act (HIPAA) Privacy Rule.
• All PHI is kept confidential, and only shared to the extent permitted by federal and state law. Data is aggregated to reflect just the presence or absence of a particular procedure at the health plan's level. These activities are considered health care operations under the HIPAA Privacy Rule and patient authorization is not required.
• Under your Cigna provider agreement, you are required to cooperate with the HEDIS/QRS data collection process. No authorization from your patients is required.

Cigna also provides health benefit services to individuals covered by Taft-Hartley and Federal Employee Health Benefit (FEHB) plans as part of our shared administration program. FEHB plans within the shared administration product collect their own HEDIS data each year and may send separate requests.

*HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).
¹ NCQA is a private, non-profit organization dedicated to improving health care quality