What is HEDIS®?
HEDIS is an acronym for Health Effectiveness Data Information Set. HEDIS was developed by the National Committee for Quality Assurance (NCQA) and is a widely used set of performance measures in the managed care industry. BCBSMT is required by state law to meet minimum standards of network adequacy and quality of care and use HEDIS measures. HEDIS measures are an essential tool in ensuring that our members are getting the best possible health care.
The tips sheets define criteria for meeting the HEDIS guidelines for important measures. They serve as a guide for the common questions regarding what HEDIS requires for documentation, and timing of health care screening and follow up.
Important HEDIS Guidelines:
- A measure description
- Information on exclusions from the measure
- Tips for HEDIS scores
- Billing codes related to each measure
If you have any HEDIS and medical record retrieval questions or would like a report regarding the results of medical records you provided us for HEDIS, please contact the Quality Improvement Team directly at 406-437-6827.
2020-21 HEDIS Tip Sheets
- Initiation and Engagement of Substance Abuse or Dependence Treatment (IET)
- Follow Up After Hospitalization for Mental Illness (FUH)
- Follow-Up Care for Children Prescribed ADHD Medication (ADD)
- Antidepressant Medication Management (AMM)
- Diabetes Screening for Members Taking Antipsychotics (SSD)
- Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
- Use of Opioids from Multiple Providers (UOP)
2018 HEDIS Tip Sheets
- Breast Cancer Screening (BCS)
- Cervical Cancer Screening (CCS)
- Childhood Immunization Status (CIS)
- Colorectal Cancer Screening (COL)
- Immunizations for Adolescents
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)
Why Does BCBSMT Collect HEDIS Data?
Blue Cross and Blue Shield of Montana (BCBSMT) is required by state law (MCA 33-36-101, et. Seq., The Managed Care Plan Network Adequacy and Quality Assurance Act) to meet minimum standards of network adequacy and quality of care and to use HEDIS measures.
HEDIS data allows BCBSMT to demonstrate the performance of BCBSMT provider networks relative to other managed care organizations operating in Montana and nationally.
HEDIS data allows managed care organizations to identify opportunities for improvement and to implement appropriate interventions.
HEDIS questions? Call 800-447-7828, Extension 6462.