HEDIS® Medical Record Requests
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
These requests are permissible under new privacy regulations, including HIPAA. Specific authorization is NOT required from our members prior to releasing medical records to us. Section 164.506 indicates the routine form you obtain is sufficient for disclosures to carry out healthcare operations. Section 164.501 defines healthcare operations to include quality assessment and improvement activities.
Submit Gaps in Care Medical Records
1. Access the provider portal at: MediGold.com/For-Providers/Provider-Portal.
a. For first-time users, follow the easy steps at the link to set up an account
and log in.
2. On the portal home page, select Close Gaps in Care.
a. Enter content in all required fields on the ‘Gaps in Care Medical Records’ tab.
3. Select the ‘Attachments’ tab. Add your medical record attachment(s), then select Add.
4. Return to the ‘Gaps in Care Medical Records’ tab and select Submit.
For more detailed instructions, click on the Gaps in Care PDF.
Gaps in Care
Medical Record Confidentiality
MediGold strictly maintains the confidentiality of any records, which are only accessed by authorized people adhering to the following guidelines. Records are:
- Kept in a safe and secure location
- Appropriately destroyed when they are no longer needed for the purpose requested
- Not further disclosed or otherwise distributed
We are not asking for nor do we want any medical record information related to psychotherapy, HIV, substance abuse or developmental disabilities.
Further, your MediGold Provider Agreement stipulates that copies of members’ medical records shall be provided to MediGold, or its respective designees, for quality improvement activities (e.g., HEDIS®).
If you have questions around this request, please contact: StarsAndHedis@mchs.com.