CommercialDocumentationMedium impact
Transitions of Care HEDIS® measures
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice·Physician
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island emphasizes new HEDIS Transitions of Care measures requiring specific documentation for patient transitions from inpatient/ED settings. Billing teams must ensure proper documentation of admission notifications, discharge information receipt, post-discharge visits, and medication reconciliation within specified timeframes.
Action Required
By April 1, 2025: Billing and clinical staff must implement documentation protocols for HEDIS Transitions of Care measures. Document receipt of inpatient admission notifications within 3 days, ensure discharge information is received and documented within 3 days of discharge (including practitioner info, test results, procedures, diagnoses, medications, and care instructions), schedule and document follow-up visits within 30 days of discharge, and complete medication reconciliation within 30 days. Update EMR templates to include required documentation elements and dates. Contact patients within 7 days of discharge notification to schedule follow-up visits.