Upcoming Annual HEDIS Medical Record Review

Date: January 31, 2025

Attention: All Providers

Review Period: February – April 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to inform network providers that the Healthcare Effectiveness and Data Information Set (HEDIS) medical record data review process will begin in February 2025 and continue through April 17, 2025. We have contracted with Virtix Health/Complex Care Solutions (a wholly owned subsidiary of Inovalon, Inc.) to retrieve medical records and perform HEDIS medical record data abstraction on our behalf. 

All medical records must be sent in to Virtix Health/Complex Care Solutions by Monday, April 17, 2025. Please note the following:

• Virtix Health/Complex Care Solutions serves as TCHP’s Business Associate as that terms is defined by the Health Insurance Portability and Accountability Act (HIPAA). 
• Virtix Health/Complex Care Solutions is ethically and legally bound to protect, preserve and maintain the confidentiality of any Protected Health Information (PHI) it collects from clinical records provided by medical practice locations pursuant to its contractual obligations to TCHP.
• PHI that is used or disclosed for purposes of treatment, payment or health care operations is permitted by HIPPA and does not require consent or authorization from the member/patient. 
• In this setting, please be assured that Virtix Health/Complex Care Solutions will treat your patients’ PHI with the utmost protection and confidentiality.

Information for submitting medical records: Virtix Health/Complex Care Solutions will contact your office to request copies of chart components to be sent via fax, mail, or through the secure provider portal for review. For any questions regarding the requested information or data collection process, please contact Virtix Health/Complex Care Solutions. 

Virtix Health/Complex Care Solutions' contact information is below:

Phone: 786-233-0168

Fax: 956-368-7983

Mail:

Virtix Health/Complex Care Solutions Client Record Processing
6509 Windcrest Dr. Suite 165
Plano, TX 75024

Provider Portal: cclinxportal.virtixhealth.com

(Providers will receive a cover sheet with your username and password details to access the portal)

Next step for providers: Please reply to any requests from Virtix Health/Complex Care Solutions within 3 to 5 business days, as this is a time-sensitive project. 

Virtix Health/Complex Care Solutions is committed to the protection of all patient information and reminds providers to carefully follow the instructions in the request to ensure accurate data is provided while adhering to the minimum information release guidelines.

Next step for providers: Providers are encouraged to inform their staff of this communication. Providers can contact their Provider Relations Liaison to address any questions or concerns about this process. Click here for a link to the contact information. 

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.