No. Replace this with, “Determine if enrollment was continuous 43 days prior to delivery through 60 days after delivery, with no gaps.”
Exchange 2020
FAQ Directory
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11.16.2020 Prenatal and Postpartum Care (PPC) Step 3 of the event/diagnosis states, “Determine if enrollment was continuous 43 days prior to delivery through 56 days after delivery, with no gaps.” Is this correct?
11.16.2020 VSD for the Quality Rating System The same OID is listed for the Systolic Greater Than or Equal To 140 Value Set and the Systolic Less Than 140 Value Set in the QRS Value Set Directory. Is this correct?
10.15.2020 Osteoporosis Screening in Older Women A dispensed dementia medication (Dementia Medications List) is listed as an exclusion in the eligible population. What time frame is required for the dispensing event?
The measure specification contains a formatting error and “A dispensed dementia medication (Dementia Medications List)” is intended to be a dash under the second bullet: “Any of the following during the measurement year or the year prior to the measurement year (count services that occur over both years).”
HEDIS 2021
10.15.2020 Inclusion of Dental and Vision Denials and Appeals for UM File Review Should denials and appeals for dental and vision requests be included in the UM denial and appeal file review universes?
For all product lines, dental and vision requests covered under the organization's medical benefit are within the scope of medical necessity review and must be included for UM file review for denials (UM 4-7) and appeals (UM 9), as outlined in the file review instructions.
Dental and vision requests not covered under medical benefits are not within the scope of denial and appeal file review.
HP 2020
9.15.2020 Childhood Immunization Status (CIS) Does the live attenuated influenza vaccine (LAIV) vaccination have to be given on the child’s second birthday?
Yes. The LAIV vaccination only counts if it is administered on the child’s second birthday. The minimum age for LAIV is 2 years, so vaccines given before that age do not meet criteria. You can view the recommendation guidelines on the CDC website (https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf).
HEDIS 2021
9.15.2020 Controlling High Blood Pressure (CBP) and Comprehensive Diabetes Care (CDC) Do BP readings taken by the member need to meet the member-reported requirements included in General Guideline 39?
No. BPs taken by the member do not need to meet requirements for member-reported data described in General Guideline 39 (collected by a PCP or other specialist while taking the patient’s history). If the BP result is documented in the member’s medical record, it may be used to assess numerator criteria if the BP does not meet any exclusion criteria (bullets at the bottom of page 157 and 195 in HEDIS MY 2020 and MY 2021 Volume 2).
HEDIS 2021
9.15.2020 Well-Child Visits in the First 30 Months of Life (W30) & Child and Adolescent Well-Care Visits (WCV) Given that the hybrid reporting option was retired from the W30 and WCV measures, what are the required data elements for supplemental data?
Because W30 and WCV are administrative only, the services and documentation in the supplemental data (e.g., medical record) must be clinically synonymous with the codes in the measure’s administrative specification. The organization determines this and it is reviewed by the auditor. Supplemental data must adhere to requirements in General Guideline 31 of the HEDIS Volume 2 MY 2020 & MY 2021 specifications.
HEDIS 2021
9.15.2020 Well-Child Visits in the First 30 Months of Life (W30) & Child and Adolescent Well-Care Visits (WCV) When reporting the W30 and WCV measures using supplemental data, may organizations combine documentation from multiple visits to meet criteria?
8.19.2020 Data Elements Table When reporting a measure as hybrid, should the data element “Number of numerator events by administrative data in eligible population (before exclusions)” be equal to the sum of “Numerator events by administrative data” and “Numerator events by supplemental data”?
Yes. This is true if the organization loads its supplemental data before approval. If the organization does not load its supplemental data until after approval is complete then “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.”
Appendix 4—Data Element Definitions of the MY 2020 & 2021 Volume 2 Technical Specifications includes an explanation of the data elements and how they are reported.
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2021
8.19.2020 Data Elements Table When reporting a measure as hybrid, should the data element “Number of numerator events by administrative data in eligible population (before exclusions)” be equal to the sum of “Numerator events by administrative data” and “Numerator events by supplemental data”?
Yes. This is true if the organization loads its supplemental data before approval. If the organization does not load its supplemental data until after approval is complete then “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.”
Appendix 4—Data Element Definitions of the MY 2020 & 2021 Volume 2 Technical Specifications includes an explanation of the data elements and how they are reported.
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2020
8.19.2020 Prenatal and Postpartum Care If a member has multiple enrollment segments without any gaps leading up to the delivery date, should we use the beginning of the first such segment as the start of the last enrollment segment?
Yes. Use the beginning of the first segment as the start of the last enrollment segment. For HEDIS Volume 2 MY 2020 & 2021, multiple enrollment segments with no gaps are treated the same as one enrollment segment with no gaps.
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2021
8.19.2020 Prenatal and Postpartum Care Do telehealth visits meet criteria for both rates and for both data collection methods?
Yes. Services provided during a telephone, e-visit or virtual check-in are eligible for use in reporting for both rates (Timeliness of Prenatal Care and Postpartum Care) and for both data collection methods (administrative and hybrid).
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2021