FAQ Directory: HEDIS

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12.02.2019 Prenatal and Postpartum Care The PPC measure defines an enrollment segment as a period of continuous enrollment with no gaps. The “last enrollment segment” is used in calculating the timelines of prenatal care numerator and is defined as the enrollment segment during the pregnancy with a start date closest to the delivery date. How do organizations identify the last enrollment segment for a member who has multiple enrollment segments?

For HEDIS 2020 reporting, enrollment segments are determined based on enrollment data provided by the health plan. If a plan provides the member's enrollment in different products/product lines as different enrollment segments, or even enrollment in the same product/product lines as different enrollment segments, the start date of the last enrollment segment must be used.

HEDIS 2020