Introduction to HEDIS® 2016
Presented by the Quality Improvement Department at
Gold Coast Health Plan
Ventura County’s Medi-Cal Managed Care Plan
Serving Ventura County since July 1, 2011
1
Contents
I. What is HEDIS®?
II. HEDIS® Measures GCHP Reports
III. HEDIS® Measure Definitions
III. Reasons for Low HEDIS® Rates
IV. How to Improve your HEDIS® Rates
2
What is
®
HEDIS ?
3
What is HEDIS®?
HEDIS® is a standardized set of
performance measures called Healthcare
Effectiveness Data Information Set which
are developed and maintained by the
National Committee for Quality Assurance
(NCQA).
4
Who participates in HEDIS®?
• Over 90% of America’s health plans (Medicare,
Medicaid, and commercial) participate in
HEDIS® quality reviews.
• California’s Medi-Cal Managed Care Plans are
mandated by the Department of Health Care
Services (DHCS) to report HEDIS® measures
annually.
5
Purpose of HEDIS®
• Health Plans use HEDIS® reviews to:
►Evaluate quality of care and services provided
to health plan members
►Evaluate accessibility of care
►Develop performance improvement initiatives
►Perform outreach to providers and members
►Compare performance with other health plans
6
Reporting HEDIS® Rates
• HEDIS® measures evaluate the previous year’s clinical
data.
– For example, most HEDIS® rates reported in 2016 are based on
clinical services performed in 2015.
– Some measures, such as Cervical Cancer Screening, look for
services performed up to 5 years prior to the reporting year.
• Results of HEDIS® reviews are reported to DHCS and
NCQA in June each year.
• GCHP distributes HEDIS® Provider Report Cards in
June & July.
7
HEDIS® Timeline
Month
HEDIS® Meetings
HEDIS ®
Training
September
X
X
October
X
X
November
X
December
Data
Integration
Runs
HEDIS ®
Audit
Activity
Medical
Record
Retrieval
Medical
Record
Review
HEDIS ®
Submissions
Measure
Improvement
Projects
X
Q3 Run
X
X
X
X
X
X
X
X
X
January
X
X
February
X
X
March
X
April
X
May
Q4 Run
X
Roadmap
X
X
X
X
X
X
X
Convenience
Samples
X
X
X
X
Preliminary
Rates
X
X
X
X
X
Medical
Record Review
Validations
X
June
X
X
Final Rates
X
July
X
August
X
Q1 Run
Q2 Run
Audit
Results
X
X
X
8
What does HEDIS® measure?
HEDIS® consists of 88 measures across the following 7 domains
of care:
1. Effectiveness of Care
2. Access/Availability of Care
3. Experience of Care
4. Utilization and Risk Adjusted Utilization
• NCQA combined “Utilization” with “Risk Adjusted Utilization” in 2015.
5. Relative Resource Use
• NCQA removed the “Utilization” measures from this domain in 2015. Previously this domain
was titled “Utilization and Relative Resource Use”.
6. Health Plan Descriptive Information
7. Measures Collected Using Electronic Clinical Data Systems
• New domain added by NCQA in 2015.
9
Clinical Data Reviewed for HEDIS®
Reporting
•
•
•
•
•
•
•
Claims data
Encounter data
Pharmacy data
Medical records
Member data
Provider data
Supplemental clinic data such as:
•
•
•
•
Lab
Vision
Immunization
Electronic medical records
10
Two Types of Measures
►Hybrid measures
►Population size reviewed: Sample size of up to 411 eligible members
randomly selected
►Requires reviewing claims, encounter, and supplemental data (e.g.
labs, Rx, Vision, CAIR, etc.).
►Require reviewing medical record documentation to validate if members
received the service or care being measured.
►Admin measures
►Population sized reviewed: Entire eligible population
►Requires reviewing only claims, encounter and supplemental data (e.g.
labs, Rx, Vision, CAIR, etc.).
►No medical record reviews required.
11
®
HEDIS
Measures
GCHP Reports
12
HEDIS® Measure
Type of Measure
Domain
Sub-Domain
1
Weight Assessment & Counseling for Nutrition &
Physical Activity for Children & Adolescents
Hybrid
Effectiveness of Care
Prevention & Screening
2
Childhood Immunization Status
Hybrid
Effectiveness of Care
Prevention & Screening
3
Immunizations for Adolescents
Hybrid
Effectiveness of Care
Prevention & Screening
4
Cervical Cancer Screening
Hybrid
Effectiveness of Care
Prevention & Screening
5
Avoidance of Antibiotic Treatment in Adults with Acute
Bronchitis
Admin
Effectiveness of Care
Overuse/Appropriateness
6
Use of Imaging Studies for Low Back Pain
Admin
Effectiveness of Care
Overuse/Appropriateness
7
Medication Management for People with Asthma
Admin
Effectiveness of Care
Respiratory Conditions
8
Controlling High Blood Pressure
Hybrid
Effectiveness of Care
Cardiovascular
9
Comprehensive Diabetes Care
Hybrid
Effectiveness of Care
Diabetes
10
Annual Monitoring for Patients on Persistent
Medications
Admin
Effectiveness of Care
Medication Management
11
Children & Adolescent Access to PCPs
Admin
Access & Availability of Care
Access & Availability of Care
12
Prenatal & Postpartum Care
Hybrid
Access & Availability of Care
Access & Availability of Care
13
Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life
Hybrid
Utilization & Risk Adjusted
Utilization
Utilization
14
Ambulatory Care
Admin
Utilization & Risk Adjusted
Utilization
Utilization
13
®
HEDIS
Measure
Definitions
14
Domain: Effectiveness of Care
Sub-Domain: Prevention & Screening
15
Weight Assessment & Counseling for Nutrition & Physical
Activity in Children & Adolescents (WCC)
•
The percentage of 3 to 17 year old children and adolescents who had an outpatient visit with a
PCP or OB/GYN and who received ALL of the following three services during the 2015
measurement year:
► BMI percentile assessment
► Counseling for nutrition
► Counseling for physical activity
•
Three separate rates are reported for each service
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Medical records
•
Hybrid Measure
•
NCQA’s Changes to the WCC Measure in 2015
► Documentation of BMI value for adolescents aged 16-17 is no longer accepted – BMI
percentile must be documented
► Documentation of anticipatory guidance related to safety (e.g. wears helmet or water safety)
without specific mention to physical activity recommendations no longer meets criteria for
counseling for physical activity.
16
Codes to Identify WCC
Description
ICD-9-CM
Diagnosis
ICD-10-CM
Diagnosis
BMI Percentile, Pediatric <5%
V85.51
Z68.51
BMI Percentile, Pediatric 5% to
<85%
BMI Percentile, Pediatric 85% to
<95%
BMI Percentile, Pediatric ≥ 95%
V85.52
Z68.52
V85.53
Z68.53
V85.54
Z68.54
Counseling for Nutrition
V65.3
Z71.3
Counseling for Physical Activity
V65.41
Outpatient Visits
CPT
97802-97804
HCPCS
UB Revenue
G0270-G0271,
G0447, S9449,
S9452, S9470,
S9449
G0447, S9451
99201-99205, 99211- 99215,
99241-99245, 99341-99345,
99347-99350, 99381-99387,
99391-99397, 99401-99404,
99411-99412, 99420, 99429,
99455-99456
G0402, G4038,
G4039, G0463,
T1015
0510-0523,
0526-0529,
0982-0983
17
Childhood Immunization Status (CIS)
•
The percentage of 2-year old children who had the following childhood immunizations
between 42-days after birth and on or before their 2nd birthday:
►
►
►
►
►
►
►
•
4 DTaP (diphtheria, tetanus, and acellular pertussis)
3 IPV (polio)
1 MMR (measles, mumps, rubella)
3 HiB (H influenza type B)
3 Hep B (Hepatitis B) – newborn Hep B vaccine administered during 8-day period after birth is acceptable
1 VZV (chicken pox)
4 PCV (pneumococcal conjugate)
Eight rates reported:
► One rate for each of the seven immunizations
► One combo rate reported showing the percentage of children who had all seven
immunizations
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Medical records
► CAIR Immunization Registry
•
Hybrid Measure
18
Codes to Identify CIS
Immunization
CPT
ICD-9-CM Diagnosis
ICD-10-CM Diagnosis
DTaP
90698, 90700, 90721,
90723
IPV
90698, 90713, 90723
MMR
90707, 90710
Measles and rubella
90708
Measles
90705
055.0, 055.1, 055.2, 055.71,
055.79, 055.8, 055.9
B05.0 – B05.4, B05.81, B05.89, B05.9
Mumps
90704
072.0 – 072.3, 072.71, 072.72,
072.79, 072.8, 072.9
B26.0 – B26.3, B26.81 – B26.85, B26.89,
B26.9
Rubella
90706
056.00, 056.01, 056.09, 056.71,
056.79, 056.8, 056.9
B06.00-B06.02, B06.09, B06.81-B06.82,
B06.89, B06.9
19
Codes to Identify CIS
Immunization
CPT
HCPCS ICD-9-CM Diagnosis
ICD-10-CM Diagnosis
HiB
9064590648,
90698,
90721, 90748
Hepatitis B
90723,
G0010
90740,
90744,
90747, 90748
070.20-070.23, 070.30070.33, V02.61
B16.0-B16.2, B16.9, B17.0,
B18.0, B18.1, B19.10,
B19.11, Z22.51
VZV
90710,90716
052.0-052.2, 052.7052.9, 053.0, 053.10053.14, 053.19-053.22,
053.29, 053.71, 053.79,
053.8, 053.9
B01.0, B01.11, B01.12,
B01.2, B01.81, B01.89,
B01.9, B02.0, B02.1, B02.21B02.24, B02.29-B02.34,
B02.39, B02.7 – B02.9
Pneumococcal
Conjugate
90669, 90670 G0009
ICD-9-PCS
99.55
ICD-10-PCS
3E0234Z
20
Immunization for Adolescents (IMA)
•
The percentage of 13-year old adolescents who had the following
immunizations:
► 1 Meningococcal between the member’s 11th and 13th birthday
► 1 Tdap/Td between the member’s 10th and 13th birthday
•
Three rates are reported:
► One rate for each immunization
► One combo rate reported showing the percentage of adolescents who had both
immunizations
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Medical records
► CAIR Immunization Registry
•
Hybrid Measure
21
Codes to Identify IMA
Description
CPT
Tetanus vaccine
90703
Td vaccine
90714, 90718
Tdap vaccine
90715
Diphtheria vaccine
90719
Meningococcal vaccine
90733, 90734
22
Cervical Cancer Screening (CCS)
•
Measures the percentage of women, between the ages of 21 to 64, who
had one of the following cervical cancer screenings:
1.
2.
Women, aged 21-64, who had a cervical cytology screening within the last
3 years
Women, aged 30-64, who had a cervical cytology/HPV co-screening
within the last 5 years
•
One rate reported
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Medical records
► Labs
•
Hybrid Measure
23
Codes to Identify CCS
Description
CPT
Cervical Cancer
Screening
88141-88143, 8814788150, 88152-88154,
88164-88167, 8817488175
HPV Screening
87620, 87621, 87622
HCPCS
G0123-G0124, G0141G0145, G0147-G0148,
P3000-P3001, Q0091
LOINC
10524-7, 18500-9,
19762-4, 19764-0,
19765-7, 19766-5,
19774-9, 33717-0,
47527-7, 47528-5
UB Revenue
0923
21440-3, 30167-1,
38372-9, 49896-4,
59420-0, 75406-9,
75694-0
24
Domain: Effectiveness of Care
Sub-Domain: Respiratory Conditions
25
Medication Management for People with
Asthma (MMA)
•
The percentage of members, 5 to 64 years of age, who were identified as
having persistent asthma and were dispensed appropriate medications that
they remained on during the treatment period.
•
Two rates are reported
► The percentage of members who remained on an asthma controller
medication for at least 50% of their treatment period
► The percentage of members who remained on an asthma controller
medication for at least 75% of their treatment period
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Pharmacy data
• Administrative measure
26
Codes to Identify MMA
Description
Asthma
ICD-9-CM
493.00, 493.01, 493.02,
493.10, 493.11, 493.12,
493.81, 493.82, 493.90,
493.91, 493.92
ICD-10-CM
J45.20-J45.22, J45.30-J45.32,
J45.40-J45.42, J45.50-J45.52,
J45.901-J45.902, J45.909,
J45.990, J45.991, J45.998
CPT
Outpatient
99201-99205, 99211-99215,
99217-22220, 99241-99245,
99341-99345, 99347-99350,
99381-99387, 99391-99397,
99401-99404, 99411-99412,
99420, 99429, 99455-99456
ED
99281-99285
Acute
Inpatient
99221-99223, 99231-99233,
99238-99239, 99251-99255,
99291
HCPCS
G0402,
G0438,
G0439,
G0463,
T1015
UB Revenue
0510-0517, 05190523, 0526-0529,
0982-0983
0450-0452, 0456,
0459, 0981
0100-0101, 01100114, 0119-0124,
0129-0134, 01390144, 0149-0154,
0159-0160, 0164,
0167, 0169, 02000204, 0206-0214,
0219, 0720-0724,
0729, 0987 27
Domain: Effectiveness of Care
Sub-Domain: Cardiovascular
28
Controlling High Blood Pressure (CBP)
• The percentage of 18 to 85 year old adults who had a diagnosis of
hypertension and whose blood pressure was adequately controlled
in 2015 based in the following criteria:
► Members 18 to 59 years of age whose BP was < 140/90
► Members 60 to 85 years of age with diabetes whose BP was <140/90
► Members 60 to 85 year of age without diabetes whose BP was <150/90
• One rate reported for all three groups
• Data reviewed to identify compliance with measure:
► Medical records
• Hybrid Measure
29
Codes to Identify CBP
Description
ICD-9-CM
Diagnosis
Essential Hypertension
Malignant Hypertension
401.0
Benign Hypertension
401.1
Hypertension, NOS
401.9
Outpatient Visits
ICD-10-CM
Diagnosis
I10
CPT
HCPCS
99201-99205, 99211-99215,
99241-99245, 99341-99345,
99347-99350, 99381-99387,
99391-99397, 99401-99404,
99411-99412, 99420, 99429,
99455-99456
G0402, G0438,
G0439, G0463
30
Domain: Effectiveness of Care
Sub-Domain: Diabetes
31
Comprehensive Diabetes Care (CDC)
•
The percentage of 18 to 75 year old adults with diabetes (Type 1 & 2) who had the
following six screenings:
•
Six rates reported:
► Hemoglobin A1c (HbA1c) testing
► HbA1c poor control (>9.0%)
► HbA1c control (<8.0%)
► Diabetic retinal eye exam
► Medical attention for nephropathy that includes a nephropathy screening,
monitoring test or evidence of nephropathy.
► Blood Pressure control (<140-90 mm Hg)
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Vision claims
► Medical records
► Labs
•
Hybrid Measure
32
Codes to Identify
Members with Diabetes
Description
Diabetes
ICD-9-CM
250.00. 250.01, 250.02, 250.03,
250.10, 250.11, 250.12, 250.13,
250.20, 250.21, 250.22, 250.23,
250.30, 250.31, 250.32, 250.33,
250.40, 250.41, 250.42, 250.43,
250.50, 250.51, 250.52, 250.53,
250.60, 250.61, 250.62, 250.63,
250.70, 250.71, 250.72, 250.73,
250.80, 250.81, 250.82, 250.83,
250.90, 250.91, 250.92, 250.93,
357.2, 362.01, 362.02, 362.03,
362.04, 362.05, 362.06, 362.07,
366.41, 648.00, 648.01, 648.02,
648.03, 648.04
ICD-10-CM
E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321,
E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36,
E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52,
E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630,
E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01,
E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331,
E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40,
E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610,
E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641,
E11.649, E11.65, E11.69, E11.8, E11.9, E13.00, E13.01, E13.10, E13.11,
E13.21, E13.22, E13.29, E13.311, E13.319, E13.321, E13.329, E13.331,
E13.339, E13.341, E13.349, E13.351, E13.359, E13.36, E13.39, E13.40,
E13.41, E13.42, E413.43, E13.44, E13.49, E13.51, E13.52, E13.59,
E13.610, E13.618, E13.620, E13.621, E13.622, E13.628, E13.630, E13.638,
E13.641, E13.649, E13.65, E13.69, E13.8, E13.9, O24.011, 024.012,
024.013. 024.019, 024.02, 024.03, 024.111, 024.112, 024.113, 024.119,
024.12, 024.13, 024.311, 024.312, 024.313, 024.319, 024.32, 024.33,
024.811, 024.812, 024.813, 024.819, 024.82, 024.83
33
Codes to Place of
Diabetic Services
Description
Outpatient
Observation
ED
CPT
99201-99205, 99211-99215,
99241-99245, 99341-99345,
99347-99350, 99381-99387,
99391-99397, 99401-99404,
99411-99412, 99420, 99429,
99455-99456
99217- 99220
99281, 99282, 99823, 99284,
99285
Nonacute Inpatient 99304-99310, 99315, 99316,
99318, 99324-99328, 9933499337
Inpatient
99221, 99222, 99223, 99231,
99232, 99233, 99238, 99239,
99251, 99252, 99253, 99254,
99255, 99291
CPT Category II
G0402, G0438, G0439,
G0463, T1015
LOINC
0510-0517, 0519-0523, 0526-0529, 0982-0983
0450, 0451, 0452, 0456, 0459, 0981
0118, 0128, 0138, 0148, 0158, 0190-0194, 0199,
0524, 0525, 0550-0552, 0559-0663, 0669
0100, 0101, 0110-0114, 0116-0124, 0126-0134, 01360144, 0146-0154, 0156-0160, 0164, 0167, 0169-0174,
0179, 0190-0194, 0199-0204, 0206-0214, 0219, 07200724, 0729, 0987, 1000-1002
34
Codes to Identify HbA1c
Screening for Diabetic
Members
Description
HbA1c Tests
CPT
83036, 83037
CPT Category II
3044F, 3045F, 3046F
HbA1c Levels < 7.0 %
3044F
HbA1c Levels 7.0 – 9.0 %
3045F
HbA1c Levels > 9.0 %
3046F
LOINC
17856-6, 4548-4, 4549-2
35
Codes to Identify
Retinal Eye Exams for
Diabetic Members
Description
Diabetic Retinal
Screening
Negative Diabetic
Retinal Screening
CPT
67028, 67030, 67031, 67036, 67039, 67040,
67041, 67042, 67043, 67101, 67105, 67107,
67108, 67110, 67112, 67113, 67121, 67141,
67145, 67208, 67210, 67218, 67220, 67221,
67227, 67228, 92002, 92004, 92012, 92014,
92018, 92019, 92134, 92225, 92226, 92227,
92228, 92230, 92235, 92240, 92250, 92260,
99203, 99204, 99205, 99213, 99214, 99215,
99242, 99243, 99244, 99245
CPT Category II
2022F, 2024F,
2026F,
HCPCS
S0620, S0621, S0625,
S3000
3072F
36
Codes to Identify
Screening/Monitoring
for Nephropathy
Description
Evidence of
Nephropathy
Treatment
ICD-9-CM
250.40-250.43, 403.00, 403.01, 403.10, 403.11,
403.90, 403.91, 404.00-404.03, 404.10-404.13,
404.90-404.93, 405.01, 405.11, 405.91, 580.0,
580.4, 580.81, 580.89, 580.9, 581.0-581.3, 581.81,
581.89, 581.9, 582.0, 582.1, 582.2, 582.4, 582.81,
582.89, 582.9, 583.0-583.2, 583.4, 583.6, 583.7,
583.81, 583.89, 583.9, 584.5-584.9, 586, 587,
588.0, 588.1, 588.81, 588.89, 588.9, 753.0,
753.10-753.17, 753.19, 791.0
Description
CPT
Nephropathy 81000, 81001,
Screening Test 81002, 81003,
81005, 82042,
82043, 82044,
84156
ICD-10-CM
CPT Category II
E08.21, E08.22, E08.29, E09.21, E09.22 E09.29, E10.21, 3066F, 4010F
E10.22, E10.29, E11.21, E11.22, E11.29, E13.21,
E13.22, E13.29, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2,
I15.0, I15.1, N00.0-N00.9, N01.0-N01.9, N02.0-N02.9,
N03.0-N03.9, N04.0-N04.9, N05.0-N05.9, N06.0-N06.9,
N07.0-N07.9, N08, N14.0-N14.4, N17.0, N17.1, N17.2,
N17.8, N17.9, N18.1-N18.6, N18.9, N19, N25.0, N25.1,
N25.81, N25.89, N25.9, N26.1, N26.2, N26.9, Q60.0Q60.6, Q61.00-Q61.02, Q61.11, Q61.19, Q61.2-Q61.5,
Q61.8, Q61.9, R80.0-R80.3, R80.8, R80.9
CPT Category II
LOINC
3060F, 3061F,
11218-5, 12842-1, 13705-9, 13801-6, 14585-4, 14956-7, 14957-5, 14958-3, 14959-1,
3062F
1753-3, 1754-1, 1755-8, 1757-4, 18373-1, 20454-5, 20621-9, 21059-1, 21482-5, 268011, 27298-9, 2887-8, 2888-6, 2889-4, 2890-2, 30000-4, 30001-2, 30003-8, 32209-9,
32294-1, 32551-4, 34366-5, 35663-4, 40486-3, 40662-9, 40663-7, 43605-5, 43606-3,
43607-1, 44292-1, 47558-2, 49023-5, 50561-0, 50949-7, 53121-0, 53525-2, 53530-2,
53531-0, 53532-8, 56553-1, 57369-1, 57735-3, 5804-0, 58448-2, 58992-9, 59159-4,
60678-0, 63474-1, 9318-7
37
Codes to Identify
Evidence of
Nephropathy
Description
ICD-9-CM
ICD-9-PCS
CKD Stage 4 585.4
ICD-10-CM
ICD-10-PCS
CPT
HCPCS
Revenue Codes
N18.4
ESRD
585.5, 585.6,
V45.11,
V45.12
38.95, 39.27, N18.5, N18.6, 3E1M39Z,
39.42, 39.43, Z91.15, Z99.2 5A1D00Z,
39.53, 39.93,
5A1D60Z
39.94, 39.95,
54.98
36147, 36800, 36810,
36815, 36818-36821,
36831-36833, 90935,
90937, 90940, 90945,
90947, 90957-90962,
90965, 90966, 90969,
90970, 90989, 90993,
90997, 90999, 99512
G0257,
S9339
0800-0804, 0809,
0820-0825, 0829-0835,
0839-0845, 0849-0855,
0859, 0880-0882, 0889
Kidney
Transplant
V42.0
55.61, 55.69
50300, 50320, 50340,
50360, 50365, 50370,
50380
S2065
0367
Z94.0
0TY00Z0,
0TY00Z1,
0TY00Z2,
0TY10Z0,
0TY10Z1,
0TY1072
38
Domain: Effectiveness of Care
Sub-Domain: Medication Management
39
Annual Monitoring for Patients on Persistent
Medications (MPM)
•
•
The percentage of adults, 18 years of age and older, who received at least
180 treatment days of ambulatory medication therapy for a select
therapeutic agent during the measurement year and had at least one
therapeutic monitoring event for the therapeutic agent during the
measurement year.
Four rates are reported for the following therapeutic agents:
►
►
►
►
•
Angiotensin Converting Enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB)
Digoxin
Diuretics
Total rate
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Pharmacy Data
► Labs
•
Administrative measure
40
Codes to Identify MPM
Description
CPT
LOINC
Lab Panel
80047, 80048, 80050,
88053, 80069
Digoxin Level
80162
3563-4, 10535-3
Serum Potassium (K+)
80051, 84132
12812-4, 12813-2, 22760-3, 2823-3, 2824-1, 29349-8, 32713-0, 39789-3, 39790-1,
41656-0, 51618-7, 6298-4
Serum Creatinine (SCr)
82565, 82575
11041-1, 11042-9, 12195-4, 13441-1, 13442-9, 13443-7, 13446-0, 13447-8,
13449-4, 13450-2, 14682-9, 16188-5, 16189-3, 21232-4, 2160-0, 2163-4, 2164-2,
26752-6, 31045-8, 33558-8, 35203-9, 35591-7, 35592-5, 35593-3, 35594-1,
38483-4, 39955-0, 39956-8, 39957-6, 39958-4, 39959-2, 39960-0, 39961-8,
39962-6, 39963-4, 39964-2, 39965-9, 39966-7, 39967-5, 39968-3, 39969-1,
39970-9, 39971-7, 39972-5, 39973-3, 39974-1, 39975-8, 39976-6, 40112-5,
40113-3, 40114-1, 40115-8, 40116-6, 40117-4, 40118-2, 40119-0, 40120-8,
40121-6, 40122-4, 40123-2, 40124-0, 40125-7, 40126-5, 40127-3, 40128-1,
40248-7, 40249-5, 40250-3, 40251-1, 40252-9, 40253-7, 40254-5, 40255-2,
40256-0, 40257-8, 40258-6, 40264-4, 40265-1, 40266-9, 40267-7, 40268-5,
40269-3, 40270-1, 40271-9, 40272-7, 40273-5, 44784-7, 50380-5, 50381-3,
51619-5, 51620-3, 59826-8, 59834-2, 62425-4
41
Domain: Effectiveness of Care
Sub-Domain: Overuse/Appropriateness
NCQA Added New Sub-Domain in 2015
42
Avoidance of Antibiotic Treatment in Adults
with Acute Bronchitis (AAB)
•
The percentage of 18 to 64 year old adults with a diagnosis of acute bronchitis
who were not dispensed an antibiotic prescription.
•
One rate reported
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Rx data
•
Administrative measure
•
NCQA’s Changes to the AAB Measure in 2015
► AAB measure moved from Respiratory Conditions sub-domain to
Overuse/Appropriateness sub-domain
43
Codes to Identify AAB
Description
Acute
Bronchitis
Outpatient
Visits
Emergency
Department
Visits
ICD-9-CM
Diagnosis*
466.0
ICD-10-CM
Diagnosis
CPT
HCPCS
UB Revenue
J20.3-J20.9
99201-99205, 99211-99215, 9921799220, 99241-99245, 99341-99345,
99347-99350, 99381-99387, 9939199397, 99401-99404, 99411-99412,
99420, 99429, 99455-99456
99281 - 99285
G0402
G0438
G0439
G0463
T1015
0510-0517,
0519-0523,
0526-0529,
0982-0983
0450-0452,
0456, 0459,
0981
44
Use of Imaging Studies for Low Back Pain
(LBP)
•
The percentage of members (any age) with a primary diagnosis of low
back pain who did not have an imaging study within 28 days of the
diagnosis.
•
One rate reported
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
•
Administrative measure
•
NCQA’s Changes to the LBP Measure in 2015
► LBP measure moved from Musculoskeletal Conditions sub-domain to
Overuse/Appropriateness sub-domain
45
Codes to Identify LBP
Description
Low Back Pain
ICD-9-CM Diagnosis
ICD-10-CM Diagnosis
721.3, 722.10, 722.32, 722.52, 722.93, 724.02, 724.03,
724.2, 724.3, 724.5, 724.6, 724.70, 724.71, 724.79,
738.5, 739.3, 739.4, 846.0, 846.1, 846.2, 846.3, 846.8,
846.9, 847.2
M46.46-M46.48, M47.26-M47.28, M47.816-M47.818,
M47.896-M47.898, M48.06-M48.08, M51.16, M51.17,
M51.26, M51.27, M51.36, M51.37, M51.46, M51.47, M51.86,
M51.87, M53.2X6 - M53.2X8. M53.3, M53.86 - M53.88,
M54.30 - M54.32, M54.40- M54.42, M54.5, M54.89, M54.9,
M99.83, M99.84, S33.100A, S33.100D, S33.100S, S33.110A,
S33.110D, S33.110S, S33.120A, S33.120D, S33.120S,
S33..130A, S33.130D, S33.130S, S33.140A, S33.140D,
S33.140S, S33.5XXA, S33.6XXA, S33.8XXA, S33.9XXA,
S39.002A, S39.002D, S39.002S, S39.0012A, S39.012D,
S39.012S, S39.029A, S39.029D, S39.029S, S39.82XA, S39.82XD,
S39.82XS, S39.92XA, S39.92XD, S39.92XS
46
Codes to Identify LBP
Description
CPT
Osteopathic Manipulative Study
98925 - 98929, 98940 - 98942
Imaging Study
72010, 72020, 72052, 72100, 72110,
72114, 72120, 72131, 72132, 72133,
72141, 72142, 72146, 72147, 72148,
72149, 72156, 72158, 72200, 72202,
72220
Outpatient Visits/Observation
99201 - 99205, 99211 - 99215, 99217 9220, 99241 - 99245, 99341 - 99345,
99347 - 99350, 99381 - 99387, 99391 99397, 99401 - 99404, 99411 - 99412,
99420, 99429, 99455 - 99456
Emergency Department Visits
99281 - 99285
HCPCS
UB Revenue
0320, 0329, 0350, 0352 ,
0359, 0610, 0612, 0614, 0619,
0972
G0402, G0438, G0439. G0463,
T1015
0510 - 0517, 0519 - 0523,
0526 - 0529, 0982 - 0983
0450, 0451, 0452, 0456, 0459,
0981
47
Domain: Access and Availability of Care
48
Children & Adolescents’ Access to PCPs
(CAP)
•
The percentage of members:
► 12 months to 6 years old who had a visit with a PCP during the measurement
year (2015)
► 7 to 19 years old who had a visit with a PCP during the measurement year
(2015) or the year prior to the measurement year (2014)
•
Four rates are reported for the following age groups:
►
►
►
►
12 to 24 months
25 months to 6 years
7 to 11 years
12 to 19 years
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
•
Administrative measure
49
Codes to Identify CAP
Description
Wellness Exams
Ambulatory Visit
Wellness Visits
ICD-9-CM
Diagnosis
V20.2
V70.0
V70.3
V70.5
V70.6
V70.8
V70.9
ICD-10-CM
Diagnosis
Z00.00 – Z00.01,
Z00.121, Z00.129,
Z00.5, Z00.8,
Z02.0-Z02.6,
Z02.71, Z02.81Z02.83, Z02.89,
Z02.9
CPT
HCPCS
99201-99205, 9921199215, 99241-99245,
99341-99345, 9934799350, 99381-99387,
99391-99397, 9940199404, 99411-99412,
99420, 99429
UB REV
0510-0517,
0519-0523,
0526-0529,
0982-0983
G0402, G4038,
G4039, G0463,
T1015
50
Prenatal & Postpartum Care (PPC)
• The percentage of women with live birth deliveries, between
November 6, 2014 and November 5, 2015, who had prenatal and
postpartum care visits.
• Two rates are reported:
► Prenatal Care: The percentage of women who had a prenatal care visit
during the first trimester or within 42 days of enrollment with their health
plan
► Postpartum Care: The percentage of women who had a postpartum
care visit between 21 and 56 days after delivery
• Data reviewed to identify compliance with measure:
► Claims and encounter data
► Medical records
•
Hybrid measure
51
Codes to Identify Members for
the Prenatal and Postpartum
Care Measure
Description
Pregnancy
Diagnosis
ICD-9-CM
ICD-10 –CM
640.x3, 641.x3,
642.x3, 643.x3,
644.x3, 645.x3,
646.x3, 647.x3,
648.x3, 649.x3,
651.x3, 652.x3,
653.x3, 654.x3,
655.x3, 656.x3,
657.x3, 658.x3,
659.x3, 678.x3,
679.x3, V22.0V22.2, V23.0V23.3, V23.41,
V23.42, V23.49,
V23.5, V23.7,
V23.81-V23.87,
V23.89, V23.9,
V28.0-V28.6,
V28.81, V28.82,
V28.89, V28.9
O09.0x, O09.1x, O09.21x, O09.29x, O09.3x, O09.4x, O09.51x, O09.52x, O09.61x, O09.62x, O09.7x, O09.81x, O09.82x, O09.89x, O09.9x,
O10.1x, O10.21x, O10.31x, O10.41x, O10.91x, O11.x, O12.0x, O12.1x, O12.2x, O13.x, O14.0x, O14.1x, O14.2x, O14.9x, O15.0x, O15.1,
O15.9, O16.x, O20.x, O21.x, O22.0x, O22.1x, O22.2x, O22.3x, O22.4x, O22.5x, O22.8Xx, O22.9x, O23.0x, O23.1x, O23.2x, O23.3x,
O23.4x, O23.51x, O23.52x, O23.59x, O23.9x, O24.01x, O24.11x, O24.31x, O24.41x, O24.81x, O24.91x, O25.1x, O26.0x, O26.1x,
O26.2x, O26.3x, O26.4x, O26.5x, O26.61x, O26.71x, O26.81x, O26.82x, O26.83x, O26.84x, O26.85x, O26.86, O26.87x, O26.89x,
O26.9x, O28.x, O29.01x, O29.02x, O29.09x, O29.11x, O29.12x, O29.19x, O29.21x, O29.29x, O29.3Xx, O29.4x, O29.5Xx, O29.6x,
O29.8Xx, O29.9x, O30.00x, O30.01x, O30.02x, O30.03x, O30.04x, O30.09x, O30.10x, O30.11x, O30.12x, O30.19x, O30.20x, O30.21x,
O30.22x, O30.29x, O30.80x, O30.81x, O30.82x, O30.89x, O30.9x, O31.00Xx, O31.01Xx, O31.02Xx, O31.03Xx, O31.10Xx, O31.11Xx,
O31.12Xx, O31.13Xx, O31.20Xx, 031.21Xx, O31.22Xx, O31.23Xx, O31.30Xx, O31.31Xx, O31.32Xx, O31.33Xx, O31.8X1x, O31.8X2x,
O31.8X3x, O31.8X9x, O32.0XXx, O32.1XXx, O32.2XXx, O32.3XXx, O32.4XXx, O32.6XXx, O32.8XXx, O32.9XXx, O33.0 - O33.2,
O33.3XXx, O33.4XXx, O33.5XXx, O33.6XXx, O33.7-O33.9, O34.0x, O34.1x, O34.2x, O34.3x, O34.4x, O34.51x, O34.52x, O34.53x,
O34.59x, O34.6x, O34.7x, O34.8x, O34.9x, O35.0XXx, O35.1XXx, O35.2XXx, O35.3XXx, O35.4XXx, O35.5XXx, O35.6XXx, O35.7XXx,
O35.8XXx, O35.9XXx, O36.011x, O36. 012x, O36.013x, O36.019x, O36.091x, O36.092x, O36.093x, O36.099x, O36.111x, O36.112x,
O36.113x, O36.119x, O36.191x, O36.192x, O36.193x, O36.20Xx, O36.21Xx, O36.22Xx, O36.23Xx, O36.4XXx, O36.511x, O36.512x,
O36.513x, O36.519x, O36.591x, O36.592x, O36.593x, O36.599x, O36.60Xx, O36.61Xx, O36.62Xx, O36.63Xx, O36.70Xx, O36.71Xx,
O36.72Xx, O36.73Xx, O36.80Xx, O36.812x, O36.813x, O36.819x, O36.821x, O36.822x, O36.823X, O36.829x, O36.891x, O36.892x,
O36.893x, O36.899x, O36.90Xx, O36.91Xx, O36.92Xx, O36.93Xx, O40.1XXx, O40.2XXx, O40.3XXx, O40.9XXx, O41.00Xx, O41.01Xx,
O41.02Xx, O41.03Xx, O41.101x, O41.102x, O41.103x, O41.109x, O41.121x, O41.122x, O41.123x, O41.129x, O41.141x, O41.142x,
O41.143x, O41.149x, O41.8X1x, O41.8X2x, O41.8X3x, O41.8X9x, O41.90Xx, O41.91Xx, O41.92Xx, O41.93Xx, O42.00, O42.01x, O42.02,
O42.10, O42.11x, O42.12, O42.90, O42.91x, O42.92, O43.01x, O43.02x, O43.10x, O43.11x, O43.12x, O43.19x, O43.21x, O43.22x,
O43.23x, O43.81x, O43.89x, O43.9x, O44.0x, O44.1x, O45.00x, O45.01x, O45.02x, O45.09x, O45.8Xx, O45.9x, O46.00x, O46.01x,
O46.02x, O46.09x, O46.8Xx, O46.9x, O47.0x, O47.1, O47.9, O48.x, O60.0x, O71.0x, O71.1-O71.7, O71.8x, O71.9, O88.01x, O88.11x,
O88.21x, O88.31x, O88.81x, O91.01x, O91.03, O91.11x, O91.03, O91.21x, O91.23, O92.01x, O92.03, O92.11x, O92.13, O92.3-O92.6,
O92.7x, O98.01x, O98.11x, O98.21x, O98.31x, O98.41x, O98.51x, O98.61x, O98.71x, O98.81x, O98.91x, O99.01x, O99.11x, O99.21O99.213, O99.280-O99.283, O99.310-O99.313, O99.320-O99.323, O99.330-O99.333, O99.340-O99.343, O99.350-O99.353, O99.41x,
O99.51x, O99.61x, O99.71x, O99.810, O99.820, O99.840-O99.843, O9A.11x, O9A.21x, O9A.31x, O9A.41x, O9A.51x, Z03.7x, 52
Z33.x,
Z34.0x, Z34.8x, Z34.9x, Z36
Codes to Identify Members for
the Prenatal and Postpartum
Care Measure
Description
Live Deliveries
ICD-9-CM
640.x1, 641.x1, 642.x1, 642.x2,
643.x1, 644.21, 645.x1, 646.x1,
646.x2, 647.x1, 647.x2, 648.x1,
648.x2, 649.x1, 649.x2, 650,
651.x1, 652.x1, 653.x1, 654.x1,
654.x2, 655.x1, 656.01, 656.11,
656.21, 656.31, 656.51, 656.61,
656.71, 656.81, 656.91, 657.01,
658.x1, 659.x1, 660.x1, 661.x1,
662.x1, 663.x1, 664.x1, 665.x1,
665.x2, 666.x2, 667.x2, 668.x1,
668.x2, 669.x1, 669.x2, 670.02,
671.x1, 671.x2, 672.02, 673.x1,
673.x2, 674.x1, 674.x2, 675.x1,
675.x2, 676.x1, 676.x2, 678.x1,
679.x1, 679.x2, V27.0, V27.2,
V27.3, V27.5, V27.6
ICD-9-PCS
ICD-10-PCS
72.0, 72.1, 72.21, 72.29, 10D00Z0, 10D00Z1, 10D00Z2, 10D07Z3, 10D07Z4,
72.31, 72.39, 72.4, 72.51- 10D07Z5, 10D07Z6, 10D07Z7, 10D07Z8, 10D17ZZ,
72.54, 72.6, 72.71, 72.79, 10D18ZZ, 10D27ZZ, 10D28ZZ, 10E0XZZ
72.8, 72.9, 73.01, 73.09,
73.1, 73.21, 73.22, 73.3,
73.4, 73.51, 73.59, 73.6,
73.8, 73.91-73.94, 73.99,
74.0-74.2, 74.4, 74.99
CPT
59400, 59409,
59410, 59510,
59514, 59515,
59610, 59612,
59614, 59618,
59620, 59622
53
Codes to Identify
Prenatal Office Visits
Description
CPT
Prenatal
59400, 59425, 59426, 59510,
Bundles Visits
59610, 59618
Billed on date of
delivery
Prenatal Visits
80055, 99201- 99205, 9921199215, 99241-99245, 99500
CPT Category II
HCPCS
UB
Revenue
H1005
0500F, 0501F, 0502F
G0463, H1000, H1001,
H1002, H1003, H1004,
T1015
0514
54
Codes to Identify Prenatal
Screenings
Description
ICD-9-PCS ICD-10-PCS
Prenatal Ultrasound 88.78
Antibody
Screenings:
Taxoplasmy,
Rubella, Herpes
Simplex, or
Cytomegalovirus
ABO Screening
Rh Screening
ABO and Rh
Screening
BY49ZZZ,
BY4BZZZ,
BY4CZZZ,
BY4DZZZ,
BY4FZZZ,
BY4GZZZ
CPT
76801,
76805,
76811,
76813,
7681576821,
7682576828
86644,
86694,
86695,
86696,
86762,
86777,
86778
86900
86901
LOINC
10350-7, 11598-0, 12261-4, 12262-2, 13225-8, 13279-5, 13280-3, 13286-0, 13323-1, 13324-9, 13501-2, 13505-3,
13949-3, 14213-3, 15377-5, 16714-8, 16715-5, 16716-3, 16944-1, 16949-0, 16950-8, 16954-0, 16955-7, 16957-3,
16958-1, 17550-5, 17717-0, 17850-9, 17851-7, 19106-4, 21326-4, 21327-2, 21570-7, 22239-8, 22241-4, 22244-8,
22246-3, 22247-1, 22249-7, 22339-6, 22341-2, 22343-8, 22496-4, 22497-2, 22577-1, 22580-5, 22582-1, 22584-7,
23485-6, 23486-4, 23784-2, 24014-3, 24116-6, 24119-0, 24242-0, 25298-1, 25300-5, 25420-1, 25435-9, 25514-1,
25542-2, 25837-6, 25839-2, 26927-4, 27948-9, 30325-5, 30355-2, 31411-2, 31616-6, 32170-3, 32687-6, 32688-4,
32790-8, 32791-6, 32831-0, 32834-4, 32835-1, 32846-8, 33291-6, 33336-9, 34152-9, 34403-6, 34421-8, 34422-6,
34613-0, 35281-5, 35282-3, 36921-5, 40466-5, 40667-8, 40677-7, 40678-5, 40697-5, 40728-8, 40729-6, 40785-8,
40786-6, 41123-1, 41124-9, 41149-6, 41399-7, 41763-4, 42337-6, 42338-4, 42949-8, 43028-0, 43030-6, 43031-4,
43111-4, 43180-9, 43810-1, 44008-1, 44480-2, 44494-3, 44507-2, 45210-2, 45326-6, 47230-8, 47307-4, 47363-7,
47389-2, 47390-0, 47430-4, 48784-3, 49107-6, 49539-0, 49848-5, 50694-9, 50758-2, 5121-9, 5122-7, 5124-3,
5125-0, 5126-8, 5127-6, 51915-7, 51916-5, 51931-4, 5202-7, 5203-5, 5204-3, 5205-0, 5206-8, 5207-6, 5208-4,
5209-2, 5210-0, 52976-8, 52977-6, 52981-8, 52984-2, 52986-7, 5330-6, 5331-4, 5332-2, 5333-0, 5334-8, 5335-5,
53377-8, 53560-9, 5387-6, 5388-4, 5389-2, 5390-0, 5391-8, 56990-5, 56991-3, 57321-2, 59838-3, 63462-6, 78519, 7852-7, 7853-5, 7907-9, 7908-7, 7909-5, 7910-3, 7911-1, 7912-9, 7913-7, 8013-5, 8014-3, 8015-0, 8039-0,
8040-8, 9422-7, 9513-3
883-9, 57743-7
10331-7, 1305-2, 34961-3, 972-0, 978-7
882-1, 884-7
55
Codes to Identify Postpartum
Visits
Description
Postpartum
Visits
ICD-9-CM
ICD-10-CM
V24.1, V24.2, V25.11,
Z01.411, Z01.419,
V25.12, V25.13, V72.31, Z01.42, Z30.430,
V72.32, V76.2
Z39.1, Z39.2
CPT
57170, 58300,
59430, 99501
Postpartum
Bundled
Visits
59400, 59410,
59510, 59515,
59610, 59614,
59618, 59622
Cervical
Cytology
88141, 88142,
88143, 88147,
88148, 88150,
88152, 88153,
88154, 88164,
88165, 88166,
88167, 88174,
88175
CPT
Category
II
0503F
HCPCS
LOINC
UB
ICD-9-PCS
Revenue
G0101
G0123, G0124,
G0141, G0143,
G0144, G0145,
G0147, G0148,
P3000, P3001,
Q0091
89.26
10524-7, 18500-9, 0923
19762-4, 19764-0,
19765-7, 19766-5,
19774-9, 33717-0,
47527-7, 47528-5
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Domain: Utilization and Risk Adjusted
Utilization
NCQA revised domain in 2015 from “Utilization and
Relative Resource Use” to “Utilization and Risk
Adjusted Utilization”
57
Well-Child Visits in the 3rd, 4th, 5th, and 6th
Years of Life (W34)
•
The percentage of 3 to 6 year old children who had one or more well-child visit(s) with a
PCP in 2015 and the provider of care assessed and documented ALL of the following:
► Health history
► Physical developmental history
► Mental developmental history
► Physical Exam
► Health education/anticipatory guidance
•
One rate reported
•
Data reviewed to identify compliance with measure:
► Claims and encounter data
► Medical records
•
Hybrid measure
58
Codes to Identify W34
Description
Well care exam
ICD-9-CM Diagnosis
ICD-10-CM Diagnosis
CPT
V20.2, V70.0, V70.3, V70.5, Z00.00, Z00.01, Z00.121,
V70.6, V70.8, V70.9
Z00.129, Z00.5, Z00.8,
Z02.0-Z02-6, Z02.71,
Z02.79, Z02.81-Z02.83,
Z02.89, Z02.9
Annual Wellness Visit
Office Visit
HCPCS
G0438, G0439
99381-99385,
99391-99395,
99461
59
Ambulatory Care (AMB)
• This measures summarizes utilization of ambulatory care in 2015 in
the outpatient and emergency department.
• Two rates reported:
► Outpatient utilization
► Emergency Department utilization
• Data audited to identify compliance with measure:
► Claims and encounter data
• Administrative measure
60
Codes to Identify AMB
Description
CPT
Ambulatory
Outpatient Visits
92002, 92004, 92012, 92014, 9920199205, 99211-99215, 99241-99245,
99304-99310, 99315-99316, 99318,
99324-99328, 99334-99337, 9934199345, 99347-99350, 99381-99387,
99391-99397, 99401-99404, 9941199412, 99420, 99429, 99461
Emergency
Department
99281-99285
HCPCS
G0463, T1015
UB Revenue
POS
0510-0517,
0519-0529,
0982-0983
0450-0452,
0456, 0459,
0981
23
61
Codes to Identify AMB
Description
CPT
Emergency
Department Visit
99281-99285
ED Procedure Code
10030, 10040, 10060, 10061, 10080, 10081, 10120, 10121, 10140, 10160, 10180. 11000,
11001, 11004-11006, 11008, 11010-10012, 10042-10047, 10055-10057, 11100, 11101,
11200, 11201, 11300 -11208, 11310-11313, 11400-11406, 11420-11424, 11426, 1144011446, 11450, 11451,
UB Revenue
0450-0452, 0456,
0459, 0981
POS
23
23
62
Reasons for Low
®
HEDIS Rates
63
Reason for Low HEDIS® Rates
• Clinics did not submit claims or encounter data
– No data = No history of services performed
• Coding on claims and encounter data is incomplete or inaccurate
– Incomplete or inaccurate coding = No history of services performed
•
•
•
•
•
•
Delayed claims & encounter submissions
Medical record documentation is incomplete
Patients did not receive annual screenings
Patients with chronic conditions are not monitored
Patients on persistent medications are not monitored
Clinics are not familiar with HEDIS® measure criteria
64
How to Improve your
®
HEDIS Rates
65
How to Improve your HEDIS® Rates
• Timely submission of all claims and encounter data
• Complete and accurate coding of all services performed
• Document all services and care provided in the medical record
–
Include child and adolescent counseling for nutrition and physical activity
• Schedule patients for their annual screenings and check-ups
–
Children are expected to have annual check-ups
• Continually monitor patients with chronic conditions
• Continually monitor patients on persistent medications
• Understand the HEDIS® measure criteria and the standard practice
guidelines
66
2016 Medical Codes for HEDIS® Reporting
To obtain a complete list of the medical codes used by NCQA to
identify compliance with HEDIS® measures click on the following
link, NCQA’s Quality Rating System HEDIS® Value Set Directory or
visit www.NCQA.org.
67
®
HEDIS
Questions?
Please email HEDIS® questions to
hedis@goldchp.org
68