Yes; because the Prescreen Status Code criteria requires a code to be in conjunction with another code, the codes must be on the same claim (claims on the same date of service cannot be combined to meet criteria).
HEDIS 2018
FAQ Directory: HEDIS
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10.15.2017 Children With Chronic Conditions When assessing Prescreen Status Code criteria, does the visit code and diagnosis code have to be on the same claim?
10.15.2017 Transitions of Care Please clarify the September 15 FAQ stating that SNPs and MMPs are not required to report the TRC measure because it does not appear in Table 3 of the CMS reporting requirements memo. Are SNP and MMPs plans required to report TRC in their contract-level submission?
10.15.2017 ECDS What is ECDS?
Electronic Clinical Data Systems (ECDS) are a network of databases containing plan members’ personal health information and records of their experiences with the health care system. ECDS may also support other care-related activities, directly or indirectly, through various interfaces that include evidence-based decision support, quality management and outcome reporting.
HEDIS 2018
10.15.2017 ECDS May we use claims for ECDS reporting?
Administrative claims are considered an ECDS data source if the payment system is automated and data are accessible by the practitioner/practitioner group that is accountable for clinical services provided to plan members (e.g., if claims are used to identify an inpatient stay, the primary care provider must be able to access the details of the stay). Report all measure results identified by claims in the “Administrative claims” source system of record (SSoR) category.
HEDIS 2018
10.15.2017 ECDS What HEDIS Effectiveness of Care measures will move to ECDS?
NCQA is evaluating existing HEDIS measures, eCQMs and other de novo measure concepts for inclusion in the ECDS domain. Selected measures will be reengineered and retested, as necessary, and must be approved by the CPM before their release in ECDS, consistent with other HEDIS measures.
HEDIS 2018
10.15.2017 ECDS What auditing process and documentation are required for ECDS sources?
The audit process for HEDIS ECDS measures is evolving. Data sources fall under audit requirements for standard supplemental data. Plans complete a Roadmap for each data source so the NCQA-Certified auditor is aware of all data that are being considered for reporting. Auditors validate policies and procedures for each data source (e.g., file layout, mapping). Although primary source verification is not required, auditors may want to validate the primary source during an initial review of data, to ensure accuracy and validity.
HEDIS 2018
10.15.2017 ECDS What is the IP-ECDS Coverage Rate threshold for public reporting of ECDS measure results?
Organizations do not report an IP-ECDS coverage rate; they report a count of members in the initial population covered by ECDS. NCQA does not publicly report these data, which are for internal NCQA use and for benchmarking analysis to help determine the timeline for public reporting.
HEDIS 2018
10.15.2017 ECDS Does the denominator only include plan members covered by ECDS who are in the initial population?
10.15.2017 ECDS Must a specific provider type be able to access ECDS sources?
10.15.2017 ECDS Clarify “data must be accessible by the health care team at point of care.”
To qualify for HEDIS ECDS reporting, practitioners/practitioner groups that are accountable for clinical services provided to members must be able to access all ECDS data used by a health plan for quality measure reporting.Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system.
HEDIS 2018
10.15.2017 ECDS What happens if members seek services from a provider who cannot share health care data using ECDS?
If a member’s data cannot be classified as ECDS, the member is not included in the ECDS coverage or the measure denominator.
There are several tools for tracking patient progress (for example, https://aims.uw.edu/resource-library/excel%C2%AE-patient-tracking-template). that “convert” data into a format that is considered an ECDS for reporting quality measures.
HEDIS 2018
10.15.2017 ECDS Must the eMeasure section in the Roadmap be completed for ECDS measures?
Plans work with their NCQA-Certified auditor to complete the most appropriate section of the Roadmap for the data source. The eMeasure section is intended for use by data aggregators and EHR vendors, but may be adapted and modified. Plans should work with auditors or contact NCQA with specific questions about the eMeasure Roadmap or Audit Roadmap Section 5.
HEDIS 2018