Medicare AdvantageDocumentationMedium impact
Discuss Preventive Care with Members
BCBS Illinois·IL·General
Effective date
Jul 16, 2026
We identified it
Jul 17, 2026
Summary
This policy emphasizes provider responsibilities to discuss and encourage preventive care with members, including screenings, vaccines, and physical exams. The guidance highlights HEDIS measurement tracking for preventive care access and provides operational recommendations (flexible scheduling, telehealth, follow-up outreach) to close care gaps and improve quality metrics.
Action Required
Effective July 16, 2026: Billing and clinical teams should implement the following: (1) Providers must document all preventive screenings and vaccines in medical records with dates and results to support HEDIS measurement reporting. (2) Front desk and billing staff should verify member eligibility and benefits before each appointment using Availity Essentials to confirm preventive service coverage and patient cost-sharing obligations. (3) Implement operational changes including flexible scheduling (evening, weekend, telehealth options) and member outreach via provider portals, email, phone, or text to reduce missed appointments and gaps in preventive care. (4) For Medicaid members, educate on non-emergency transportation services availability. (5) Reference the Quality Care 2026 HEDIS booklet in Availity Essentials for documentation and coding requirements specific to the Adults' Access to Preventive/Ambulatory Health Services measure. Failure to properly document preventive services may result in inaccurate HEDIS reporting and potential performance penalties.