FAQ Directory: HEDIS

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9.15.2022 Quality Compass Data Comparison Across All Product Lines Is there a way to compare the data across product lines?

Currently each license is separated and there is no way to compare Commercial, Medicaid and Medicare in the same license. However, with the Data Exporter function, you will be able to pull reports in Microsoft Excel and that can make data comparison easier.
 

HEDIS MY 2021

9.15.2022 PCS Questions Do answers from the Policy Clarification Support system have an expiration date?

We recommend that organizations not use PCS responses that are over 3 years old. If a question relates directly to a measure specification or a general guideline that was revised from a previous measurement year, you should resubmit the question.

HEDIS MY 2023

9.15.2022 General Guideline 32: Medicare Socioeconomic Status Stratification Which measures does General Guideline 32: Medicare Socioeconomic Status Stratification apply to?

The Hemoglobin A1c Control for Patients With Diabetes measure should be removed from the measure list. The Plan All-Cause Readmissions measure should be added to the list. This clarification will be in the MY 2023 Technical Update.

HEDIS MY 2023

9.15.2022 Follow-Up Care for Children Prescribed ADHD Medication (ADD) In step 1 of the Event/Diagnosis for Rate 1, what timeframe is used to identify dispensed ADHD medications?

In step 1 identify all children in the specified age range who were dispensed an ADHD medication during the 12-month Intake Period. This clarification will be in the MY 2023 Technical Update.

HEDIS MY 2023

9.15.2022 Follow-Up After Emergency Department Visit for Substance Use (FUA) Should the Residential Program Detoxification Value Set be used when reporting the FUA measure? It is not listed in the Value Set Directory.

Yes. The Residential Program Detoxification Value Set and codes will be included in the Update release of the Value Set Directory on March 31, 2023. The OID for the value set is 2.16.840.1.113883.3.464.1004.2408, and it includes two HCPCS codes:

  • H0010     Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) (H0010)
  • H0011   Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (H0011)

HEDIS MY 2023

8.15.2022 Quality Compass: Data Exporter What is the Data Exporter feature on Quality Compass?

All versions of Quality Compass allow users to build customized reports within the tool. Versions of Quality Compass that include the Data Exporter feature allows users to download and export those custom reports into Microsoft Excel.

The Data Exporter feature also grants access to the “All Measures Download” file. This file contains plan-level performance data for all publicly reported health plan submissions and all HEDIS and CAHPS measure results in a single downloadable file. Versions purchased without Data Exporter will not have the ability to export plan level data but will still have access to Excel versions of the benchmarks.
 

HEDIS MY 2022

8.15.2022 Individual Plan Data - Quality Compass What are the “individual plan data” available on Quality Compass?

Individual plan data are the HEDIS and CAHPS performance rates submitted by health plans that chose to publicly report their results to NCQA. Users have access to all publicly reported plans in a specific product line (commercial, Medicaid, Medicare) and can easily select a subset of plans based on coverage in different regions/states.
 

HEDIS MY 2022

5.16.2022 MY 2022 Technical Update – COL-E Measure In the updated version of the COL-E measure that was re-released in the MY 2022 Technical Update, the “Total” data element listed in the age column is not highlighted in Table COL-E-A-3: Data Elements for Colorectal Cancer Screening. Should this cell be highlighted?

Yes. The cell should be highlighted to indicate that it is calculated by IDSS.

HEDIS MY 2022

4.15.2022 Initiation and Engagement of Substance Use Disorder Treatment (IET) Should denominator episodes be deduplicated to one per day? For example, if a member has two outpatient visits with an SUD diagnosis on the same date of service (with different providers), is it one denominator episode or two?

Deduplicate denominator episodes to one per day. Two eligible SUD encounters on the same date of service count as one denominator episode.  

HEDIS MY 2022

4.15.2022 Data Aggregator Validation (DAV) Data for ECDS Reporting Can validated DAV data streams be used for ECDS reporting? If yes, how should they be categorized (which SSoR)?

Yes. If validated DAV streams are used, they should be categorized as HIE/clinical registry data sources.

HEDIS MY 2021

4.15.2022 Data Aggregator Validation (DAV) Data for ECDS Reporting Can validated DAV data streams be used for ECDS reporting? If yes, how should they be categorized (which SSoR)?

Yes. If validated DAV streams are used, they should be categorized as HIE/clinical registry data sources.

HEDIS MY 2022

2.15.2022 Guidelines for Calculations and Sampling: Hybrid Measures When reducing sample sizes for measures with stratifications, which are used: the total rates or the stratified rates?

For measures with stratifications, use the total rate when reducing sample sizes. For measures with multiple indicators and stratifications, use the lowest total rate across indicators when reducing sample sizes.

HEDIS MY 2021