HEDIS readiness for audit season

The HEDIS audit is an annual, retrospective review that validates the data and processes behind your reported HEDIS hybrid measures. It confirms that health plans followed NCQA technical specifications and used sound methods to calculate results, which directly affects Star Ratings, regulatory compliance, and competitive position. HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Obtaining complete charts is difficult because provider offices are busy, addresses and contacts may be outdated, and documentation is often spread across multiple systems or locations. Manual outreach, packet building, and spreadsheet tracking slow everything down, leading to incomplete chart coverage, higher costs, and late records that limit your ability to fix issues before submission.

Automation and AI-enabled HEDIS software can generate chase lists, send outreach, track responses, and route records to abstractors without manual intervention. They also help identify relevant documentation for each measure and provide real time visibility into sample status, reducing manual work, speeding retrieval and abstraction, and lowering the risk of missing charts or errors in your HEDIS hybrid measures submission.

Automated medical record retrieval coordinates provider outreach, follow-up, and document intake at scale so more charts are requested earlier and tracked centrally. This approach has been shown to accelerate packet delivery by weeks, which reduces last minute scrambles, improves sample completion, and gives your quality team more time to review results before the audit deadline.

Automated workflows can generate and deliver most provider packets, manage follow-ups, and reconcile responses without staff touching every record. In real implementations, healthcare organizations have saved over a thousand hours and cut outreach effort in half by replacing manual spreadsheets and packet assembly with automated HEDIS processes.

When chart collection and review follow a standardized, automated process, teams can reach more providers efficiently and track each chase from outreach through receipt. That consistency has driven retrieval rate improvements of 20%+ in some cases. Higher retrieval rates and consistent abstraction reduce missed documentation and calculation errors, which helps lower HEDIS audit risk and protect your final reported results.