FAQ Directory: HEDIS

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11.15.2019 Plan All-Cause Readmissions The PCR measure indicates that for commercial and Medicaid, organizations report only members 18–64 years of age. This is inconsistent with Table PCR-1/2/3: Plan Population and Outlier Rate (Medicaid, Commercial and Medicare, 18+) and Table PCR-A-1/2/3 : Plan All-Cause Readmissions Rates Among Nonoutlier Members by Age (Medicaid, Commercial and Medicare, 18+), which indicate that members ages 18 and older are reported for all product lines. Are these data element tables incorrect for commercial and Medicaid reporting?

Yes, the tables are incorrect. When reporting the PCR measure for the commercial and Medicaid product lines, only include members 18–64 years of age. The age ranges 65–74, 75–84, 85+ and 65+ Total included in the data element tables are only collected for Medicare reporting.
For commercial and Medicaid reporting, collect 18–44, 45–54, 55–64 and 18–64 Total. 

HEDIS 2020