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.
If screenings are done in your office, thoroughly documenting and coding them helps assess quality care for HEDIS measurements and allows us to assess appropriate programs to assist members with health conditions. The more accurately claims are coded, the fewer medical record reviews are needed for HEDIS measurement.
Sign up today for a free continuing education HPV training presentation by the Washington State Department of Health for nurses, physicians, and pharmacists.
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 ages six 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.
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 ages 18-75 who received care for diabetes (Types 1 and 2) and had each of the following:
Patients aged 18-74 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.
Patients aged 18-64 who have received the influenza vaccine during the measurement year.
Women ages 50-74 who had a mammogram to screen for breast cancer.
Women ages 21-64 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 ages 3-17 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 ages 50-75 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.)
Adolescents 13 years of age who had one dose of each:
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 ages 2-18 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.