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HEDIS Chart Chase: Record Collection Preferences Form

Instructions

To better serve you, we at Iowa Total Care are reaching out to best understand your preferred method of record collection for HEDIS medical records. We know chart chase season can be a busy time for your office and our goal is to make the upcoming season as smooth as possible. 

Please complete and submit by 12/6/2024.

Service Location Information

Please attach additional health information management (HIM) location references if applicable. Provider rosters may be provided for additional clarification.

Include city, state and ZIP code.
Please provide a general department phone number/extension. When unavailable, default to the office phone, not an individual’s.
A shared or medical record (MR) email is preferred, when available. When a MR email is unavailable, a contact email for the upcoming season is sufficient. Feel free to list all preferred emails. NOTE: We cannot accept Gmail, Yahoo, etc.

Preferred Retrieval Method

Select your preferred method of retrieval.

Copy Service Affiliation

Copy Service Affiliation

Special Handling Instructions

Anything you would like us to know or do to make MR requests go as smoothly as possible.
I would like someone to contact me regarding Supplemental Data (SDS: Supplemental Data Systems) File and/or electronic medical record (EMR) opportunities. Both can reduce the medical record request burden and potentially improve quality metrics.
Name of person submitting this form.
Email address of person submitting this form.
Phone number of person submitting this form.
Questions

 

Questions? Email the Iowa Total Care HEDIS team.