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HEDIS Chart Chase Preferences Form

Instructions

To better serve you, we at Sunflower Health Plan are reaching out to best understand your preferred method of record collection for HEDIS Medical Records. We know chart chase season can be a busy time for your office and our goal is to make the upcoming season as smooth as possible.

Please complete and submit by October 1, 2024.

Service Location Information

Including City, State and Zip Code
Please provide general department phone number/ext. When unavailable, default to the office phone, not an individual’s.
A shared or MR email is preferred, when available. When a MR email is unavailable, a contact email for the upcoming season is sufficient. Feel free to list all preferred emails. We cannot accept Gmail, Yahoo, etc.

Preferred Retrieval Method:

Select your preferred method of retrieval.

Copy Service Affiliation:

Copy Service Affiliation

Special Handling Instructions:

Anything you would like us to know or do, anything to make MR requests go as smooth as possible?
I would like someone to contact me regarding Supplemental Data (SDS (Supplemental Data Systems)) File and/or EMR opportunities. Both can reduce the medical record request burden and potentially improve quality metrics.
Name of person submitting this form.
Contact email address of person submitting this form.
Phone number of person submitting this form.