What is HEDIS?

HEDIS® (Healthcare Effectiveness Data and Information Set) consists of performance measures used by most health plans that compare how a plan performs in quality, access to care, and member satisfaction.

HEDIS® measures are collected as part of Medi-Cal, Healthy Families, and Medicare reporting.

What are the HEDIS® Measures and How are They Collected?

Measures are collected and calculated using specific CPT and ICD-9 codes found in administrative data (i.e., claims and encounters). For some measures, chart abstractions can be used to supplement the administrative data.

View a list of HEDIS® measures and accompanying codes that will count towards each HEDIS measure.

View Tips for HEDIS® Medical Records to help you ensure your charts contain information that will count for HEDIS. 

View the Alliance’s HEDIS® rates.

Why is HEDIS® Important?

The Alliance wants to ensure that we are offering quality preventive care and service to our members. HEDIS® allows us to monitor how we are performing compared to other health plans and identify areas of opportunity for improvement.

HEDIS® can help you:

  • Monitor patient’s health, prevent further complications and identify issues that may arise with their care.
  • Identify patients who have not received preventive screenings
  • Understand how you compare with other providers and the national average

What can you do to improve HEDIS® scores? 

  • Make sure that the services are performed in a timely manner and are optimal for patients
  • Submit any of the valid codes for HEDIS® on an encounter or claim
  • Document the services and results (if appropriate) in the patient’s medical chart
  • Encourage your patients to schedule preventive exams
  • Remind your patients to follow up with ordered tests
  • Complete outreach calls to patients who have missed services

If you have questions about HEDIS®, need more information, or would like a copy of the HEDIS® information, please contact the Provider Services department.