FAQ Directory: HEDIS

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2.15.2018 ECDS General Guidelines Should organizations include only paid claims for ECDS measures?

No. Organizations must include all paid, suspended, pending and denied claims for ECDS measures. Currently, ECDS General Guideline 4 states to include only services for which the reporting entity has paid or expects to pay, but because none of the other eligible sources require payment status, any claims should be accepted. The guideline is incorrect and will be corrected for HEDIS 2019

HEDIS 2018