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May 27, 2026
According to the American Academy of Pediatrics, routine well-child visits allow providers to monitor growth and developmental milestones. These visits also offer an important opportunity for our members to receive recommended immunizations that help prevent illness.
To help identify and close potential care gaps, we track the following Healthcare Effectiveness Data and Information Set (HEDIS®) measures developed by the National Committee for Quality Assurance:
Well-Child Visits in the First 30 Months of Life measures the percentage of children who had at least six well-child visits with a primary care provider during their first 15 months, and two or more well-child visits during their next 15 months.
Child Immunization Status measures the percentage of 2-year-olds who received the following vaccines by their 2nd birthday:
- Four diphtheria, tetanus and acellular pertussis
- Three polio
- One measles, mumps and rubella
- Three haemophilus influenza type B
- Three hepatitis B
- One chicken pox
- Four pneumococcal conjugate
- One hepatitis A
- Two or three rotavirus before 1 year of age
- Two influenza
Tips to consider
- Identify members who are overdue for well-child visits or immunizations, and reach out to caregivers to schedule appointments. Please note that telehealth does not meet visit requirements.
- Assess immunization status at each visit and identify any gaps. Address common misconceptions about vaccines.
- Remind our members of the importance of receiving an annual flu vaccine, as new strains of the virus emerge each year. The Centers for Disease Control and Prevention recommends that most people 6 months and older receive a flu vaccination annually.
- When documenting well-child visits, ensure that the visit was with a PCP and include the following in the medical record:
- Date of visit
- Health history
- Developmental history (physical and mental)
- Physical exam
- Height, weight and body mass index percentile
- Health education or anticipatory guidance, including physical activity, diet and nutrition
- We collect immunization data through claims and chart review. To document immunizations, you may include in the medical record any of the following:
- Certificates of immunizations or immunization flowsheet
- Diagnostic reports
- Subjective, objective, assessment and plan notes
- Office, progress or well-visit notes
- Encounter form
- Records from a previous primary care provider
- Children’s wellness guidelines
- Preventive care guidelines
- Clinical practice guidelines
- Statewide immunization information system imMTrax
The record should include each immunization given and the date it was administered. Documentation stating, “all immunizations are up-to-date" does not meet the requirements of this measure.
Resources: Refer to our Quality Care 2026 booklet on HEDIS measures for information on documentation and coding for these measures. You can access it in Availity® Essentials within our Payer Spaces in the Resources section. Other resources include:
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their member contract or member guide for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Montana. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
HEDIS is a registered trademark of NCQA.