The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of nationally recognized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS is used by more than 90 percent of U.S. health plans to measure quality of care, access to care, and satisfaction with care.
Thoroughly documenting and coding patient screenings helps us assess quality care for HEDIS measurements and establish appropriate programs for patients with specific health conditions. And, the more accurately claims are coded, the fewer medical record reviews are needed for HEDIS measurement.
Our quick reference coding guide ensures you're sending complete claims and are paid for all the services you provide.
For more information about HEDIS, visit ncqa.org.
Children 6 to 12 years of age with newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication that have at least three follow-up care visits within a 10-month period, one of which is within 30 days of when the first ADHD medication was dispensed.
Patients 18 years of age and older who were treated with antidepressants, had a diagnosis of major depression, and who remained on an antidepressant medication treatment for at least 6 months.
Two rates are reported:
Patients six years of age and older who were hospitalized for treatment of selected mental health disorders and who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization with a mental health practitioner. Two rates are reported:
This measure is the percentage of patients 18 to 85 years of age who had a diagnosis of hypertension and whose blood pressure (BP) was adequately controlled during the measurement year, based on the following criteria:
1US Department of Health and Human Services. , National Institutes of Health., National Heart, Lung, and Blood Institute., National High blood Pressure Education Program., "National High Blood Pressure Education Program" NIH Publication No. 03-5233 December 2003 Accessed March 31, 2015
Patients 18-75 years of age who received care for diabetes (Types 1 and 2) and had each of the following:
Patients 18-74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.
View the Adult BMI HEDIS tip sheet.
Patients 18-64 years of age who have received the influenza vaccine during the measurement year.
Women 50-74 years of age who had a mammogram to screen for breast cancer.
Women 21-64 years of age who were screened with cytology within the past three years and women ages 30-64 who were screened with cytology/HPV co-testing within the past five years.
Patients 3-17 years of age who had one or more outpatient visits with PCPs or OB/GYN and documented evidence of all the following during the measurement year:
Children two years of age who had four diphtheria, tetanus, and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and 10 separate combination rates.
Women ages 16-24 identified as presumed sexually active and have had at least one test for chlamydia during the measurement year.
Patients 50-75 years of age who had one of the following screenings for colorectal cancer.
Appropriate screenings are defined by one of the following:
(The HPV Vaccine for Female Adolescents was retired as its own measure and added to this measure since it's now applicable for both male and female adolescents.)
Women who delivered a live birth and experienced:
2Peter Bach et al. HEDIS 2015 Technical Specifications for Health Plans (National Committee for Quality Assurance 2014), 243-250.
Adults 18-64 years of age with a diagnosis of acute bronchitis who were not given an antibiotics prescription.
Patients 2-18 years of age who were diagnosed with pharyngitis, tonsillitis, or streptococcal sore throats who were dispensed antibiotics and received group A streptococcus (strep) tests during office or emergency room visits.
Children ages 3 months to 18 years of age who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription.