Audit Review Table Parkland Community Health Plan (Org ID: 19735, SubID: 11066, Medicaid, Spec Area: None, Spec Proj: SCHIP, Contract Number: None)
|
|
- Kelley Taylor
- 5 years ago
- Views:
Transcription
1 Audit Review Table Parkland Community Health Plan (Org ID: 19735, SubID: 11066, Medicaid, Spec Area: one, Spec Proj: SCHIP, Contract umber: one) Measurement ear ; Date & Timestamp - 6/27/2018 2:55:12 PM The Auditor lock has been applied to this submission. Measure/Data Element Benefit Offered Rate Audit Designation Comment Effectiveness of Care: Prevention and Adult BMI Assessment (aba) Weight Assessment and Counseling for utrition and Physical Activity for Children/Adolescents (wcc) BMI Percentile 72.26% R Reportable Counseling for utrition 74.94% R Reportable Counseling for Physical Activity 67.88% R Reportable Childhood Immunization Status (cis) DTaP 89.78% R Reportable IPV 94.40% R Reportable MMR 97.08% R Reportable HiB 95.38% R Reportable Hepatitis B 91.00% R Reportable VZV 96.84% R Reportable Pneumococcal Conjugate 91.73% R Reportable Hepatitis A 96.35% R Reportable Rotavirus 85.40% R Reportable Influenza 54.74% R Reportable Combination # % R Reportable Combination # % R Reportable Combination # % R Reportable Combination # % R Reportable Combination # % R Reportable Combination # % R Reportable Combination # % R Reportable Combination # % R Reportable Combination # % R Reportable Immunizations for Adolescents (ima) Meningococcal 92.46% R Reportable
2 Tdap 93.43% R Reportable HPV 39.42% R Reportable Combination # % R Reportable Combination # % R Reportable Lead Screening in Children (lsc) 72.51% R Reportable Breast Cancer Screening (bcs) Cervical Cancer Screening (ccs) Chlamydia Screening in Women (chl) ears ears Total Effectiveness of Care: Respiratory Appropriate Testing for Children with Pharyngitis (cwp) 87.24% R Reportable Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr) Pharmacotherapy Management of COPD Exacerbation (pce) Systemic Corticosteroid Bronchodilator Medication Management for People With Asthma (mma) 5-11 ears: Medication Compliance 50% 44.44% R Reportable 5-11 ears: Medication Compliance 75% 18.52% R Reportable ears: Medication Compliance 50% 37.62% R Reportable ears: Medication Compliance 75% 19.80% R Reportable ears: Medication Compliance 50% A Small Denominator ears: Medication Compliance 75% A Small Denominator ears: Medication Compliance 50% A Small Denominator ears: Medication Compliance 75% A Small Denominator Total: Medication Compliance 50% 42.07% R Reportable Total: Medication Compliance 75% 18.97% R Reportable Asthma Medication Ratio (amr) 5-11 ears 76.02% R Reportable ears 70.48% R Reportable
3 19-50 ears A Small Denominator ears A Small Denominator Total 74.09% R Reportable Effectiveness of Care: Cardiovascular Controlling High Blood Pressure (cbp) Persistence of Beta-Blocker Treatment After a Heart Attack (pbh) Statin Therapy for Patients With Cardiovascular Disease (spc) Received Statin Therapy: ears (Male) Statin Adherence 80%: ears (Male) Received Statin Therapy: ears (Female) Statin Adherence 80%: ears (Female) Received Statin Therapy: Total Statin Adherence 80%: Total Effectiveness of Care: Diabetes Comprehensive Diabetes Care (cdc) Hemoglobin A1c (HbA1c) Testing HbA1c Poor Control (>9.0%) HbA1c Control (<8.0%) HbA1c Control (<7.0%) Eye Exam (Retinal) Performed Medical Attention for ephropathy Blood Pressure Control (<140/90 mm Hg) Statin Therapy for Patients With Diabetes (spd) Received Statin Therapy Statin Adherence 80% Effectiveness of Care: Musculoskeletal Disease-Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art) Effectiveness of Care: Behavioral Antidepressant Medication Management (amm) Effective Acute Phase Treatment Effective Continuation Phase Treatment Follow-Up Care for Children Prescribed ADHD Medication (add)
4 Initiation Phase 29.33% R Reportable Continuation and Maintenance (C&M) Phase 23.33% R Reportable Follow-Up After Hospitalization for Mental Illness (fuh) Follow-Up After Emergency Department Visit for Mental Illness (fum) 30-Day Follow-Up B o Benefit 7-Day Follow-Up B o Benefit 30-Day Follow-Up B o Benefit 7-Day Follow-Up B o Benefit Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (fua 30-Day Follow-Up: ears B o Benefit 7-Day Follow-Up: ears B o Benefit 30-Day Follow-Up: 18+ ears B o Benefit 7-Day Follow-Up: 18+ ears B o Benefit 30-Day Follow-Up: Total B o Benefit 7-Day Follow-Up: Total B o Benefit Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd) Diabetes Monitoring for People With Diabetes and Schizophrenia (smd) Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc) Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa) Metabolic Monitoring for Children and Adolescents on Antipsychotics (apm) 1-5 ears 0.00% A Small Denominator 6-11 ears 16.13% R Reportable ears 25.71% R Reportable
5 Total 20.90% R Reportable Effectiveness of Care: Medication Annual Monitoring for Patients on Persistent Medications (mpm) ACE Inhibitors or ARBs Diuretics Total Effectiveness of Care: on-recommended Cervical Cancer Screening in Adolescent 0.18% R Reportable Females (ncs) Appropriate Treatment for Children With URI (uri) 91.48% R Reportable Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab) Use of Imaging Studies for Low Back Pain (lbp) Use of Multiple Concurrent Antipsychotics in Children and Adolescents (apc) 1-5 ears 0.00% A Small Denominator 6-11 ears 0.00% A Small Denominator ears 0.00% A Small Denominator Total 0.00% R Reportable Use of Opioids at High Dosage (uod) A Small Denominator Use of Opioids From Multiple Providers (uop) Multiple Prescribers A Small Denominator Multiple Pharmacies A Small Denominator Multiple Prescribers and Multiple Pharmacies A Small Denominator Access/Availability of Care Adults' Access to Preventive/Ambulatory Health Services (aap) ears ears 65+ ears Total Children and Adolescents' Access to Primary Care Practitioners (cap)
6 Annual Dental Visit (adv) Initiation and Engagement of AOD Abuse or Dependence Treatment (iet) Months 99.16% R Reportable 25 Months - 6 ears 93.84% R Reportable 7-11 ears 96.02% R Reportable ears 95.26% R Reportable 2-3 ears B o Benefit 4-6 ears B o Benefit 7-10 ears B o Benefit ears B o Benefit ears B o Benefit ears B o Benefit Total B o Benefit Alcohol abuse or dependence: Initiation of AOD Treatment: ears B o Benefit Alcohol abuse or dependence: Engagement of AOD Treatment: ears B o Benefit Opioid abuse or dependence: Initiation of AOD Treatment: ears B o Benefit Opioid abuse or dependence: Engagement of AOD Treatment: ears B o Benefit Other drug abuse or dependence: Initiation of AOD Treatment: ears B o Benefit Other drug abuse or dependence: Engagement of AOD Treatment: ears B o Benefit Total: Initiation of AOD Treatment: ears B o Benefit Total: Engagement of AOD Treatment: ears B o Benefit Alcohol abuse or dependence: Initiation of AOD Treatment: 18+ ears B o Benefit Alcohol abuse or dependence: Engagement of AOD Treatment: 18+ ears B o Benefit Opioid abuse or dependence: Initiation of AOD Treatment: 18+ ears B o Benefit Opioid abuse or dependence: Engagement of AOD Treatment: 18+ ears B o Benefit
7 Other drug abuse or dependence: Initiation of AOD Treatment: 18+ ears B o Benefit Other drug abuse or dependence: Engagement of AOD Treatment: 18+ ears B o Benefit Total: Initiation of AOD Treatment: 18+ ears B o Benefit Total: Engagement of AOD Treatment: 18+ ears B o Benefit Alcohol abuse or dependence: Initiation of AOD Treatment: Total B o Benefit Alcohol abuse or dependence: Engagement of AOD Treatment: Total B o Benefit Opioid abuse or dependence: Initiation of AOD Treatment: Total B o Benefit Opioid abuse or dependence: Engagement of AOD Treatment: Total B o Benefit Other drug abuse or dependence: Initiation of AOD Treatment: Total B o Benefit Other drug abuse or dependence: Engagement of AOD Treatment: Total B o Benefit Total: Initiation of AOD Treatment: Total B o Benefit Total: Engagement of AOD Treatment: Total B o Benefit Prenatal and Postpartum Care (ppc) Timeliness of Prenatal Care Postpartum Care Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (app 1-5 ears B o Benefit 6-11 ears B o Benefit ears B o Benefit Total B o Benefit Utilization Well-Child Visits in the First 15 Months of Life (w15) 0 Visits 0.26% R Reportable 1 Visit 0.51% R Reportable 2 Visits 1.29% R Reportable 3 Visits 2.83% R Reportable 4 Visits 3.60% R Reportable 5 Visits 15.17% R Reportable
8 6+ Visits 76.35% R Reportable Well-Child Visits in the Third, Fourth, Fifth and Sixth ears of Life (w34) 84.91% R Reportable Adolescent Well-Care Visits (awc) 71.78% R Reportable Frequency of Selected Procedures (fsp) R Reportable Ambulatory Care: Total (amba) Ambulatory Care: Dual Eligibles (ambb) Ambulatory Care: Disabled (ambc) Ambulatory Care: Other (ambd) Inpatient Utilization--General Hospital/Acute Care: Total (ipua) R Reportable Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub) Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc) Inpatient Utilization--General Hospital/Acute Care: Other (ipud) Identification of Alcohol and Other Drug Services: Total (iada) Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb) B o Benefit B o Benefit Identification of Alcohol and Other Drug Services: Disabled (iadc) B o Benefit Identification of Alcohol and Other Drug Services: Other (iadd) B o Benefit Mental Health Utilization: Total (mpta) B o Benefit Mental Health Utilization: Dual Eligibles (mptb) B o Benefit Mental Health Utilization: Disabled (mptc) B o Benefit Mental Health Utilization: Other (mptd) B o Benefit Antibiotic Utilization: Total (abxa) R Reportable Antibiotic Utilization: Dual Eligibles (abxb) Antibiotic Utilization: Disabled (abxc) Antibiotic Utilization: Other (abxd) Standardized Healthcare-Associated Infection Ratio (hai)
9 Risk Adjusted Utilization Plan All-Cause Readmissions (pcr) Health Plan Descriptive Board Certification (bcr) Enrollment by Product Line: Total (enpa) R Reportable Enrollment by Product Line: Dual Eligibles (enpb) Enrollment by Product Line: Disabled (enpc) Enrollment by Product Line: Other (enpd) Enrollment by State (ebs) R Reportable Language Diversity of Membership (ldm) R Reportable Race/Ethnicity Diversity of Membership (rdm) R Reportable Total Membership (tlm) R Reportable Measures Collected using Electronic Depression Screening and Follow-Up for Adolescents and Adults (dsf) Depression Screening: Total Total R ot Reported Follow-up on Positive Screen: Total Total R ot Reported Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (dms) Utilization of PHQ-9: Total Total R ot Reported Depression and Remission or Response for Adolescents and Adults (drr) Follow-up PHQ-9: Total Total R ot Reported Depression Remission: Total Total R ot Reported Depression Response: Total Total R ot Reported Unhealthy Alcohol Use Screening and Follow-Up (asf) Alcohol Use Screening: Total Total R ot Reported Counseling or Other Follow-up Postive Screen: Total Total R ot Reported
Audit Review Table Parkland Community Health Plan (Org ID: 19735, SubID: 11065, Medicaid, Spec Area: None, Spec Proj: None, Contract Number: None)
Audit Review Table Parkland Community Health Plan (Org ID: 19735, SubID: 11065, Medicaid, Spec Area: one, Spec Proj: one, Contract umber: one) Measurement ear - 2017; Date & Timestamp - 6/27/2018 2:54:19
More informationQuality measures desktop reference for Medicaid providers
Quality measures desktop reference for Medicaid providers providers.amerigroup.com Please note: The information provided is based on 2016 technical specifications and is subject to change based on guidance
More informationQuality measures desktop reference for Medicaid providers
Quality measures desktop reference for Medicaid providers Please note: The information provided is based on 2016 technical specifications and is subject to change based on guidance given by the National
More informationQuality measures desktop reference for Medicaid providers
Quality measures desktop reference for Medicaid providers providers.amerigroup.com Please note: The information provided is based on 2016 technical specifications and is subject to change based on guidance
More informationQuality measures desktop reference for Medicaid providers
Please note: The information provided is based on 2016 technical specifications and is subject to change based on guidance given by the National Committee for Quality Assurance (NCQA), the Centers for
More informationHEDIS QUICK REFERENCE GUIDE 2018
HEDIS HYBRID MEASURES (Hybrid measures are based on data retrieved from medical records and may include administrative data from claims) HEDIS MEASURE MEASURE DESCRIPTION HEDIS MEDICAL RECORD DOCUMENTATION
More informationAppendix 4: Summary of Recommended Changes to HEDIS/CAHPS Measure List
Appendix 4: HEDIS/CAHPS List 1 Appendix 4: Summary of Recommended Changes to HEDIS/CAHPS List Add the following new measures for the commercial, Medicare and Medicaid product lines. Please refer to the
More informationQuality Measures Desktop Reference for Medicaid Providers
https://providers.amerigroup.com Quality Measures Desktop Reference for Medicaid Providers Please note: The information provided is based on 2019 technical specifications and is subject to change based
More informationHEDIS Trends in Medi-Cal (HEDIS MY)
Trends in Medi-Cal ( - MY) Prevention and Screening 2013) ) ) ABA Adult BMI Assessment Diabetes Care CDC-HT Diabetes Care HbA1c Testing 83.8% 90.8% 90.1% -0.7 75 th 83.5% 83.5% 86.0% 2.5 50 th CDC-H8 CDC-H9
More informationHEDIS Trends in Medi-Cal (HEDIS MY)
Trends in Medi-Cal ( - MY) 2014) ) ) Prevention and Screening ABA Adult BMI Assessment Diabetes Care 90.8% 90.1% 93.9% 3.8 90 th CDC-HT CDC-H8 CDC-H9 CDC-E CDC-N Diabetes Care HbA1c Testing HbA1c Control
More informationHEDIS/QARR 2018 Quick Reference Guide ALL MEASURES
2018 HEDIS Codes HEDIS/QARR 2018 Quick Reference Guide ALL MEASURES Code Age Band Denominator Event Numerator Requirement ADL AAB AAP ABA ADV Adolescent Preventive Care Avoidance of Antibiotic in Adults
More informationPENNSYLVANIA MEDICAID AND MEDICARE Explanation of HEDIS Measures
Each year, NCQA (National Committee for Quality Assurance) publishes HEDIS (Healthcare Effectiveness Data and Information Set), a set of standardized performance measures used in the managed care industry
More information2016 HEDIS Measures and Specifications
2016 HEDIS Measures and Specifications Measure Reported Data Line of Business Children and Adolescents Adolescent immunizations (IMA) On or before age 13 Adolescent well care visits (AWC) Ages 12-21 Appropriate
More informationTrending Determinations by Measure
1100 13th Street NW, Third Floor Washington, DC 20005 phone 202.955.3500 fax 202.955.3599 www.ncqa.org TO: Interested Parties FROM: Cindy Ottone, Director, Policy DATE: March 2019 RE: HEDIS 1 2019 Measure
More informationHEDIS 2017 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING
HEDIS 2017 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 1. Follow-up Care for Children Prescribed ADHD Medication (ADD) Percent children newly
More informationCOMMUNITY HEALTH GROUP HEDIS MEASURES (CY 2012) MEDICARE QUICK REFERENCE GUIDE FOR BILLING DEPARTMENT
HEDIS MEASURES (CY ) MEDICARE QUICK REFERENCE GUIDE FOR BILLING DEPARTMENT Care for Older Adults Colorectal Cancer Screening Annual Monitoring for Patients on Persistent Medications COA COL MPM Age Description
More information2017 HEDIS Measures. PREVENTIVE SCREENING 2017 Measure Quality Indicator
PREVENTIVE SCREENING Childhood Immunization Children who turn 2 during the Adolescent Immunization Adolescents who turn 13 during the Lead Screening Children who turn 2 during the Breast Cancer Screening
More informationHEDIS 2015 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING
HEDIS 2015 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING DIABETES 1. Comprehensive Diabetes Care (CDC): Percentage of members 18-75 years of age with diabetes (type 1 and type 2) who had
More informationAdult HEDIS & STARs Measures
HEDIS AND MEDICARE STAR DOCUMENTATION & CODING GUIDE Adult HEDIS & STARs Measures Adult BMI Assessment (ABA) 18 74-year-old Antidepressant Medication Management (AMM) Breast Cancer Screening (BCS) Cervical
More informationMulti-Specialty Quality Measure Information Sheet 2017
Prevention and Screening Adolescent Preventive Care Measures (APC) The percentage of adolescents 12-17 years of age who had at least one outpatient visit with a PCP or OB/ GYN practitioner during the measurement
More informationSUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES
Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling
More information2018 Commercial HMO/POS HEDIS 1 Results
08 Commercial HMO/POS HEDIS Results Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents HEDIS 06 CY 05 HEDIS 07 CY 06 HEDIS 08 CY 07 Compass BMI Percentile 70.47%
More informationSUMMARY TABLE OF MEASURE CHANGES
Summary Table of Measure 1 SUMMARY TABLE OF MEASURE CHANGES Guidelines for Physician Measurement Adult BMI Assessment Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
More informationSUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES
Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling
More informationHEDIS 2014 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING
HEDIS 2014 MQIC MEASURES SUMMARY LISTING FOR ANNUAL PERFORMANCE REPORTING DIABETES 1. Comprehensive Diabetes Care (CDC): Percentage of members 18-75 years of age with diabetes (type 1 and type 2) who had
More informationHEDIS/QARR 2017 Quick Reference Guide ALL MEASURES
2017 HEDIS s HEDIS/QARR 2017 Quick Reference Guide ALL MEASURES Measure Age Band Denominator Event Numerator Requirement Line of Business AAB Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
More informationNCQA Health Insurance Plan Ratings Methodology October 2014
NCQA Health Insurance Plan Ratings Methodology October 2014 REVISION CHART Date Published December 2013 April 2014 October 2014 Description Draft version Final version Updated measure list with 50% rule
More informationMedicaid Managed Care Quality Measures SFY 2015
Medicaid Managed Care Quality Measures SFY 2015 The Ohio Department of Medicaid (ODM) established Quality Measures and Standards to evaluate Managed Care Plan () performance in priority areas (e.g., care
More informationNCQA Health Insurance Plan Ratings Methodology March 2019
00 3th Street NW, Third Floor Washington, DC 20005 phone 202.955.3500 fax 202.955.3599 www.ncqa.org NCQA Health Insurance Plan Ratings Methodology March 209 Better health care. Better choices. Better health.
More informationNCQA Health Insurance Plan Ratings Methodology March 2018
00 3th Street NW, Third Floor Washington, DC 20005 phone 202.955.3500 fax 202.955.3599 www.ncqa.org NCQA Health Insurance Plan Ratings Methodology March 208 Better health care. Better choices. Better health.
More informationChanges for Physician Measurement 2018
Changes for Physician Measurement 2018 Measure Name Guidelines for Physician Measurement Effectiveness of Care Changes Revised the Systematic Sampling Methodology to require organizations to report using
More informationHEDIS Documentation & Coding Guidelines 2015
Effectiveness of Care: Prevention & Screening Members 18 74 years of age who had an outpatient visit and BMI ICD-9: V85.0 - V85.45 whose body mass index (BMI) was documented during the measurement year
More informationMichigan Quality Improvement Consortium Detailed Measurement Specifications HEDIS 2015 (measurement year 2014)
Page 1 of 18 Michigan Quality Improvement Consortium Detailed Measurement Specifications HEDIS 2015 (measurement year 2014) Introduction Who is the Michigan Quality Improvement Consortium? The Michigan
More informationMEASURING CARE QUALITY
MEASURING CARE QUALITY Region November 2016 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance
More informationHealthcare Effectiveness Data and Information Set Quality Assurance Reporting Requirements
HEDIS/QARR Healthcare Effectiveness Data and Information Set Quality Assurance Reporting Requirements 2015 Quick Reference Guide ADULTS Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
More informationMichigan Quality Improvement Consortium Detailed Measurement Specifications HEDIS 2014 (measurement year 2013)
Page 1 of 18 Michigan Quality Improvement Consortium Detailed Measurement Specifications HEDIS 2014 (measurement year 2013) Introduction Who is the Michigan Quality Improvement Consortium? The Michigan
More information2017 Annual Report Healthcare Effectiveness Data and Information Set (HEDIS) Prepared by the Health Plan s Quality Management Department
2017 Annual Report Healthcare Effectiveness Data and Information Set (HEDIS) Prepared by the Health Plan s Quality Management Department Table of Contents Executive Summary 3 Introduction 5 Description
More information5 x 7 spiral bound - prints front and back sheets - 1/1 - black MEASURE DESCRIPTION
Requirements for Meeting Clinical Goals - Last Updated 11-1-2016 TABLE OF CONTENTS MEASURE ABBREVIATION AAB ABA ADD AMM AMR ART BCS CBP CCS CDC CDC CDC CDC CHL CWP CIS COL FUH IMA IET LBP MPM MEASURE DESCRIPTION
More informationAdult-Peds Quality Measure Information Sheet 2018
Prevention and Screening Adolescent Preventive Care Measures (ADL) The percentage of adolescents 12-17 years of age who had at least one outpatient visit with a PCP or OB/ GYN practitioner during the measurement
More information2019 HEDIS Summary Table of Measures, Product Lines and Changes
2019 HEDIS Summary Table of Measures, Product Lines and Changes Summary of Measure Changes HEDIS 2019 Measures General Guidelines for Data Collection and Reporting Applicable to: Changes for HEDIS 2019
More informationMEASURING CARE QUALITY
MEASURING CARE QUALITY Region December 2013 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance
More informationCY 2017 MMA Performance Measure Scores HEDIS, Core Set, and Agency-defined measures
Aetna Better Health Amerigroup Better Health Children's Medical Services Adherence to Antipsychotic Medications for Individuals with Schizophrenia 50% 60% 57% N/A 45% Adolescent Well Care Visits 62% 64%
More information2018 Blue Cross NC. Provider Quality Pocket Guide
2018 Blue Cross NC Provider Quality Pocket Guide 5 x 7 spiral bound - prints front and back sheets - 1/1 - black Requirements for Meeting Clinical Goals - Last Updated October 2017 TABLE OF CONTENTS MEASURE
More informationPediatric Quality Measure Information Sheet 2017
Prevention and Screening Adolescent Preventive Care Measures (APC) The percentage of adolescents 12-17 years of age who had at least one outpatient visit with a PCP or OB/ GYN practitioner during the measurement
More information2017 PCP INCENTIVE AWARD PROGRAM MEASURES & TIPS
Childhood Immunization Status (CIS) Combo 10 Immunizations for Adolescents (IMA) Combo 1 Lead Screening in Children (LSC) Immunizations completed prior to a child turning 2 years of age in 2017 as follows:
More informationHEDIS Pediatric Resource Guide
HEDIS Pediatric Resource Guide What s Inside Pediatric Resource Guide Pediatric and Behavioral Health Measures 1 What is HEDIS? 2 HEDIS Reference Guide for Pediatrics What Is HEDIS? The Healthcare Effectiveness
More informationth Street, NW Suite 1000 Washington, DC phone fax
TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Accreditation & Measures Policy DATE: September 19, 2016 RE: Measures for Accreditation Scoring in 2017 This communication gives
More informationPATH Quick Reference Guide: Coding for Pediatric Health HEDIS Measures
PATH Quick Reference Guide: Coding for Pediatric Health HEDIS Measures This guide is designed to be a quick reference tool to help with medical coding of select Healthcare Effectiveness Data and Information
More information2018 P4P Overview 0518.PR.P.PP.1 6/18
2018 P4P Overview Agenda MHS Pay For Performance (P4P) Ambetter P4P Program Secure Web Reporting Question and Answer What You Will Learn 1. Measure Overviews & Specifications 2. Documentation Requirements
More informationHEDIS 2018 MEASURES. Performance Ratings Operations Department
HEDIS 2018 MEASURES Performance Ratings Operations Department ABA Adult BMI Assessment Members ages 18 74 years of age What makes them compliant? Documentation in the medical record must reflect office
More informationIntroduction to HEDIS 2016 Presented by the Quality Improvement Department at Gold Coast Health Plan
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.
More informationCommercial HMO/POS Effectiveness of Care Measure
Commercial HMO/POS Effectiveness of Care Measure HEDIS 2017 NCQA Quality Compass National Average Adult BMI Assessment 91.85% 76.17% Weight Assessment and Counseling for Nutrition and Physical Activity
More informationHEDIS Quality Measure Descriptions
HEDIS Quality Measure Descriptions Updated January 18, Highlighted areas indicate change from prior version. Adolescent well care (AWC) Patients ages 12 to 21 who has at least one comprehensive well child
More informationHEDIS. Quick Reference Guide. For more information, visit
HEDIS Quick Reference Guide For more information, visit www.ncqa.org HEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2019 Technical Specifications SilverSummit Healthplan strives to provide quality
More informationth Street, NW Suite 1000 Washington, DC phone fax
TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Accreditation & Measures Policy DATE: May 15 2017 (Updated on October 18, 2017) RE: Measures for Accreditation Scoring in 2018
More informationHEDIS Pediatric Resource Guide
HEDIS Pediatric Resource Guide What s Inside Pediatric Resource Guide Pediatric and Behavioral Health Measures 1 What is HEDIS? 2 HEDIS Reference Guide for Pediatrics What Is HEDIS? The Healthcare Effectiveness
More informationPROVIDER NETWORK MANAGEMENT June 2 nd, 2016 WEBINAR KEVIN FOW BSN, RN, CCM. QUALITY IMPROVEMENT NURSE PRESENTS..
PROVIDER NETWORK MANAGEMENT June 2 nd, 2016 WEBINAR KEVIN FOW BSN, RN, CCM. QUALITY IMPROVEMENT NURSE PRESENTS.. 1 QUALITY IMPROVEMENT HEDIS Performance Improvement Projects CLINICAL PRACTICE GUIDELINES
More informationHEDIS Documentation and Coding Adult Guidelines 2017
HEDIS Documentation and Coding Adult Guidelines 2017 Reproduced with permission from HEDIS 2017, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA).
More informationMQIC GUIDELINES, MEASURES and TOOLS SUMMARY MQIC Community Results - HEDIS 2017 (Measurement Year 2016)
MQIC Community Results - 2017 (Measurement Year 2016) ADHD Diagnosis of ADHD for Children and Young Adults Treatment of ADHD for Children and Young Adults 1. Follow-up Care for Children Prescribed ADHD
More information2019 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set
209 HEDIS s Healthcare Effectiveness Data and Information Set *s collected with medical record review. Red= new/addition to measures Blue= Medicare only Prevention and Screening Adult Immunization Status
More informationHEDIS. Quick Reference Guide. For more information, visit
HEDIS Quick Reference Guide For more information, visit www.ncqa.org HEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2019 Technical Specifications Managed Health Services (MHS) strives to provide
More informationB&T Format. New Measures. Better health care. Better choices. Better health.
1100 13th Street NW, Third Floor Washington, DC 20005 phone 202.955.3500 fax 202.955.3599 www.ncqa.org TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Policy DATE: February
More informationHEDIS 2017 results are in for our Anthem PPO and Anthem HealthKeepers products
HEDIS 2017 results are in for our Anthem PPO and Anthem HealthKeepers products Anthem Blue Cross and Blue Shield thanks you for participating in the annual Healthcare Effectiveness Data and Information
More informationHEDIS 2016 results are in for our Anthem PPO and Anthem HealthKeepers products
HEDIS 2016 results are in for our Anthem PPO and Anthem HealthKeepers products Anthem Blue Cross and Blue Shield thanks you for participating in the annual Healthcare Effectiveness Data and Information
More informationHow are the scores used? Results from HEDIS data collection are used to measure quality improvement processes and preventive care programs.
Healthcare Effectiveness Data and Information Set (HEDIS) 101 What is HEDIS? Nerk Health partners with providers to offer quality health care to our members, as measured through HEDIS quality measures.
More informationHbA1c Medical Attention for Nephropathy BP control Eye Exam
Table of Contents Measure abbreviation Measure Description Page AAB Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 3 ABA Adult BMI Assessment 4 ADD Follow Up Care for Children Prescribed
More informationPreferred Care Partners. HEDIS Technical Standards
Preferred Care Partners HEDIS Technical Standards 1 HEDIS What is HEDIS HEDIS Overview Adults HEDIS Overview Pediatrics HEDIS is a registered trademark of the National Committee for Quality Assurance 2
More informationQUALITY RATING SYSTEM: BACKGROUND
QUALITY RATING SYSTEM: BACKGROUND Federally-required quality rating system Originally required for 2017, FFM delayed until 2018 in most states 5 states displaying QRS for 2017 2 FFM pilot states + CA,
More informationHEDIS Adult Resource Guide
HEDIS Adult Resource Guide What s Inside Adult Resource Guide Adult and Behavioral Health Measures 1 What is HEDIS? 2 HEDIS Reference Guide for Adults 16 How to Be a Quality Star 17 Medicare STAR Measures
More information2018 HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET /PROVIDER GUIDE
2018 HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET /PROVIDER GUIDE HEDIS / STAR PROVIDER GUIDE HEDIS 2018 HEDIS (Healthcare Effectiveness Data and Information Set) is a performance measurement tool
More informationHEDIS Quick Reference Guide
SHP_20174053 HEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2018 Technical Specifications Superior HealthPlan strives to provide quality health care to our membership as measured through Healthcare
More information2018 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set
2018 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set *Measures collected with medicalrecord review. Red= new/addition to measures Blue= Medicare only Prevention and Screening Measure
More informationMQIC GUIDELINES, MEASURES and TOOLS SUMMARY - HEDIS 2014 (Reporting year 2013)
MQIC GUIDELINES, MEASURES and TOOLS SUMMARY - 2014 (Reporting year 2013) ASTHMA General Principles for the Diagnosis and Management of Asthma BRONCHITIS Management of Uncomplicated Acute Bronchitis in
More informationGlobalHealth has improved ratings in the following HEDIS measures: Antidepressant Medication Management Continuation Phase
August 2013, Dear GlobalHealth Network Practitioners and Providers: Each year, GlobalHealth selects and examines a sample of medical records to ensure quality care is being provided to our members. These
More informationFLORIDA MEDICAID HEDIS 2010 RESULTS STATEWIDE AGGREGATE REPORT
Agency for Health Care Administration FLORIDA MEDICAID HEDIS 2010 RESULTS STATEWIDE AGGREGATE REPORT June 2011 3133 East Camelback Road, Suite 300 Phoenix, AZ 85016 Phone 602.264.6382 Fax 602.241.0757
More informationHEDIS Adult. Documentation and Coding Guidelines Medical record documentation required. Measure description. Coding ICD-10: Z68.1 Z68.45, Z68.
HEDIS Adult Documentation and Guidelines 2017 description Adult BMI Assessment (ABI) Members 18 74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement
More informationQuality measures desktop reference for medicare and medicaid providers
Quality measus desktop fence for medica and medicaid providers Anthem Blue Cross Cal MediConnect Please note: The information provided is based on HEDIS 2015 Technical Specifications and is subject to
More informationB&T Format. New Measures. Better health care. Better choices. Better health.
1100 13th Street NW, Third Floor Washington, DC 20005 phone 202.955.3500 fax 202.955.3599 www.ncqa.org TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Policy DATE: August 13,
More informationAETNA BETTER HEALTH OF WEST VIRGINIA Understanding Medicaid measure compliance and coding references
AETNA BETTER HEALTH OF WEST VIRGINIA Understanding Medicaid measure compliance and coding references HEDIS 2018 Toolkit for provider offices www.aetnabetterhealth.com/westvirginia WV 17 08 14 WV 17 10
More informationAdvances in Alignment, Measurement, and Performance MY 2017 Results Highlights
Advances in Alignment, Measurement, and Performance MY 2017 Results Highlights Align. Measure. Perform. (AMP) Programs Launched in 2003, VBP4P is a statewide performance improvement program and one of
More informationB&T Format. New Measures. 2 CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Policy DATE: February 4, 2018 RE: 2018 Accreditation Benchmarks and Thresholds This document reports national benchmarks and
More informationQuality Care Measures
QUALITY Quality Care s COMMERCIAL We value your partnership and participation in BlueCross Commercial Quality Improvement, and hope you ll find this guide helpful. The information and tips included can
More informationEvidence-Based Measure (EBMs) Definitions
Evidence-Based (EBMs) s This guide is a brief summary of the most commonly-used EBMs. All information is based on the MedInsight Evidence Based s (EBMs) User Guide (October 2015), compiled in a way most
More informationHEDIS 2014 (CY 2013) GOAL MET OR EXCEEDED
Buckeye Health Plan 2016 Medicaid Ratings: The Healthcare Effectiveness Data and Information Set () is a tool that helps health plans measure the quality of care their members receive. Buckeye uses data
More informationKEY BEHAVIORAL MEASURES
2019 HEDIS AT-A-GLANCE: KEY BEHAVIORAL MEASURES (18 Years and Older) At WellCare, we value everything you do to deliver quality care for our members your patients to make sure they have a positive healthcare
More informationIHA P4P Measure Manual Measure Year Reporting Year 2018
ADULT PREVENTIVE CARE IHA P4P Measure Manual Measure Year 2017 - Reporting Year 2018 *If line of business not labeled, measure is Commercial only Adult BMI (Medicare) 18-74 Medicare members ages 18-74
More informationWisconsin Chronic Disease Quality Improvement Project. HEDIS 2017 Summary Data
Wisconsin Chronic Disease Quality Improvement Project HEDIS 2017 Summary Data CDQIP Results: HEDIS 2017 Data Year 19 of data collection for CDQIP Plans voluntarily submit HEDIS data for selected measures
More informationQuality measures a for measurement year 2016
Quality measures a for measurement year 2016 Measure Description Eligible members Childhood immunizations b Adolescent immunizations b Children who turned 2 during the measurement and who were identified
More informationMichigan Quality Improvement Consortium 2017 Annual Performance Measurement Report
Michigan Quality Improvement Consortium Annual Performance Measurement Report Table of Contents Executive Summary.. 3-4 ADHD.. 5-6 Asthma... 7-8 Bronchitis 9 Cardiovascular. 10-17 Chronic Kidney Disease
More informationHedis Behavioral Health Measures
Hedis Behavioral Health Measures Generating better health outcomes and improving HEDIS scores is a positive outcome for everyone. Magellan Complete Care is offering support by providing the details of
More informationHEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2016 Technical Specifications
HEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2016 Technical Specifications MHS Health Wisconsin strives to provide quality healthcare to our membership as measured through HEDIS quality metrics.
More informationHEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2016 Technical Specifications
HEDIS Quick Reference Guide Updated to reflect NCQA HEDIS 2016 Technical Specifications IlliniCare Health strives to provide quality healthcare to our membership as measured through HEDIS quality metrics.
More information2018 MIPS Reporting Family Medicine
2018 MIPS Reporting Family Medicine Quality Reporting Requirements: Report on 6 quality measures or a specialty measure set Include at least ONE outcome or high-priority measure Report on patients of All-Payers
More informationCare1st Health Plan Taking Quality to the Next Level REPORTING YEAR HEDIS Summary - MPL (Measurement Year 2012)
Care1st Health Plan s Quality Improvement Department has been diligently working towards improving the Healthcare Effectiveness Data and Information Sets (HEDIS) results across all lines of business. HEDIS
More informationNCQA did not add new measures to Accreditation 2017 scoring.
2017 Accreditation Benchmarks and Thresholds 1 TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Policy DATE: August 2, 2017 RE: 2017 Accreditation Benchmarks and Thresholds
More informationHEDIS PLUS PROVIDER TRAINING
HEDIS PLUS PROVIDER TRAINING With a focus on: 2018 LDH Incentive Based or Monitoring Measures, 2018 NCQA Accreditation Measures, and 2018 AmeriHealth Caritas Louisiana Quality Enhancement Program Measures
More information2017 Physician Incentive Program by Payer
2017 Physician Incentive Program by Payer BCN Commercial Payout Summary TARGET AMOUNT per SERVICE Breast screening 80%+ $125^ Childhood immunizations ( % of who children who turn 2 in Flat fee $50 the
More information