Medicare AdvantageAdministrativeMedium impact
Provide Records to Support Quality Care for Medicare Advantage Members
BCBS Texas·TX·Government Programs
Effective date
Jan 1, 2026
We identified it
Jan 12, 2026
Summary
Blue Cross Blue Shield of Texas will request medical records from Medicare Advantage providers from January through June 2026 for HEDIS quality measures and risk adjustment reviews. Providers must promptly respond to record requests from BCBSTX or their vendor Advantmed without requiring patient authorization.
Action Required
January-June 2026: All clinical and billing staff must promptly respond to medical record requests from BCBSTX or Advantmed by fax or phone. Ensure complete and accurate records are provided for chronic conditions (diabetes, high blood pressure), transitional care, and risk adjustment chart reviews. No patient authorization is required under HIPAA health care operations.