Central California Alliance For Health

 

HEDIS Measurement (MY) 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. The Alliance is contractually required by the California State Department of Healthcare Services (DHCS) to perform the HEDIS Compliance Audit that complies with DHCS’ Managed Care Accountability Set (MCAS). The MY2019 MCAS measures align with Centers for Medicare and Medicaid Services’ (CMS) Child and Adult Core Sets, as well as with the National Committee for Quality Assurance's (NCQA) HEDIS quality measures. The audit assesses how well the Alliance network is providing services to our members, while also ensuring accurate and reliable measurement.


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 Compliance 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 that utilize claims, laboratory, immunization registries, pharmacy, and provider portal submitted data for relevant Care-Based Incentive (CBI) and HEDIS measures. These reports are available to assist providers in monitoring their patients that may be due for preventative services. 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 to increase compliance in CBI and HEDIS measures. Please see the Data Submission Tool Guide on the Provider Portal for the list of data that is accepted and step-by-step instructions on how to submit your data.


MY 2019 HEDIS Quick Reference Guide

 • MY 2019 HEDIS Quick Reference Guide


MY 2019 HEDIS Code Set

 • MY 2019 HEDIS Code Set


MY 2019 HEDIS Tip Sheets

Adolescent Well-Care Visits (AWC)

Adult Body Mass Index (BMI) Assessment (ABA)

Antidepressant Medication Management: Acute Phase and Continuation Phase Treatment (AMM-Acute & AMM-Cont)

Asthma Medication Ratio (AMR)

Breast Cancer Screening (BCS)

Cervical Cancer Screening (CCS)

Childhood Immunization Status: Combo 10 (CIS-10)

Chlamydia Screening in Women (CHL)

Comprehensive Diabetes Care (CDC) HbA1c Test & Poor Control

Controlling Blood Pressure (CBP)

Immunizations for Adolescents (IMA)

Plan All-Cause Readmissions (PCR )

Prenatal Care (PPC)

Postpartum Care (PPC)

Weight Assessment and Counseling for Nutrition & Physical Activity for Children/Adolescents: BMI Assessment for Children/Adolescents (WCC)

Well-Child Visits in the First 15 Months of Life (W15)

Well-Child Visits in the 3-6 Years of Life (W34)




MY 2019 General Resources

 

 

 

 

 

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