HEDIS^® Tip Sheets

Quality measures help ensure our members receive appropriate care. We created tip sheets to help you satisfy quality measures, including Healthcare Effectiveness Data and Information Set (HEDIS) measures* from the National Committee for Quality Assurance (NCQA).

Compliance with these measures may reduce the need for you to send medical records later for review. Except where noted, the tip sheets include measure requirements for all our members including, all fully-insured PPO, Blue Choice PPO^SM and HMO, Blue Cross Community Health Plans^SM (BCCHP^SM), Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM and Medicare Advantage members (unless otherwise specified). 

• Adult Access to Preventive/Ambulatory Health Services
• Annual Dental Visit for Children and Adolescents
• Appropriate Testing for Children with Pharyngitis 
• Appropriate Treatment for Upper Respiratory Infection
• Avoidance of Antibiotic Treatment
• Breast Cancer Screening
• Care for Older Adults  (MMAI and Medicare Advantage only)
• Cervical Cancer Screening
• Child and Adolescent Health  (Commercial and BCCHP only)
• Child and Adolescent Well-Care Visits
• Childhood Immunization Status
• Chlamydia Screening in Women
• Chronic Conditions 
• Colorectal Cancer Screening
• Comprehensive Diabetes Care
• Controlling Blood Pressure 
• Kidney Health Evaluation for Patient with Diabetes
• Lead Screening in Children
• Osteoporosis Management in Women
• Prenatal and Postpartum Care 
• Transitions of Care  (MMAI and Medicare Advantage only)
• Use of Imaging Studies for Low Back Pain
• Use of Spirometry Testing in Assessing and Diagnosing COPD

Behavioral Health

• Antidepressant Medication Management 
• Diabetes Screening for Members Taking Antipsychotics 
• Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 
• Follow-Up After Emergency Department Visit for Mental Illness
• Follow Up After Hospitalization for Mental Illness
• Follow-Up Care for Children Prescribed ADHD Medication 
• Initiation and Engagement of Substance Abuse or Dependence Treatment
• Metabolic Monitoring for Children and Adolescents on Antipsychotics 
• Use of Opioids from Multiple Providers 
• Treatment for Alcohol and Other Drugs

*Measurement year 2020 and 2021

HEDIS is a registered trademark of NCQA.

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.