HEDIS General Guideline 15: The “Working Aged” and Retirees says, “Include employees 65 years of age and older and retirees only in the product line that providers their primary coverage (Medicare or commercial).” Following this guidance, members with dual coverage in commercial and Medicare Advantage products should be reported in the plan that provides primary coverage (whether the same or a different plan). NCQA will provide further guidance on this issue in HEDIS 2019 and VBP4P will evaluate for inclusion for MY 2018.
Self-reporting POs that are unable to identify the primary insurer should use their best judgment; the overall impact is expected to be minimal and equal across plans and POs.
ALL 2017