Central California Alliance For Health


HEDIS 2020 (Measurement Year 2019)

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool developed by the National Committee for Quality Assurance (NCQA), and is used by health plans across the United States to measure performance on important dimensions of healthcare and services. It is mandated by the State of California that all Medi-Cal Managed care plans participate in the HEDIS audit.

HEDIS audit period is January through May, and measures the care that was delivered the prior year. The audit is monitored by Health Services Advisory Group (HSAG) to ensure the data is accurate and reliable. At the end of the HEDIS audit period the rates are reported publicly and are compared across all Medi-Cal Health Plans in California. The Alliance also uses the HEDIS results to focus on areas of improvement.

HEDIS Clinical Resources

The Alliance offers the following resources to assist providers in effectively delivering quality care to Alliance members in alignment with HEDIS. Please click on the links below to access information and resources to help you understand HEDIS requirements.

Provider Portal

The Alliance’s Provider Portal offers reports utilizing claims, laboratory, immunization registries, pharmacy, and provider portal entered data received on relevant CBI and HEDIS measures to assist providers in monitoring their patients and streamlining their administrative processes. Note: Data on the Provider Portal is subject to claims lag.

The Alliance’s Data Submission tool on the Provider Portal allows providers to upload data files for the following HEDIS measures. Please see the Data Submission Tool Guide on the Provider Portal for step-by-step instructions on how to submit your data.

 • Annual Monitoring for Patients on Persistent Medications (MPM): ACE/ARB

 • Cervical Cancer Screening (CCS)

 • Depression Screening and Follow-up for Adolescents and Adults (DSF)

 • Comprehensive Diabetes Care (CDC) – HbA1c Test and Good Control

 • Immunizations for Adolescents (IMA)

 • Immunizations for Children (CIS)

2020 General Resources

2020 HEDIS Quick Reference Guide

2020 HEDIS Code Set

2020 HEDIS Tip Sheets


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