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What is HEDIS®?

HEDIS stands for Healthcare Effectiveness Data and Information Set. We use HEDIS scores to measure our performance, determine quality initiatives and provide educational programs for you and our members. You can use HEDIS scores to monitor your patients’ health, identify developing issues and prevent further complications.

What is HEDIS used for?

The National Committee for Quality Assurance (NCQA) coordinates HEDIS testing and scorekeeping. The Centers for Medicare & Medicaid Services uses HEDIS scores to monitor a health plan’s performance. More than 90% of American health plans use HEDIS scores to compare how well the plan performs in areas like:

 

  • Quality of care
  • Access to care
  • Member satisfaction with the plan and providers

HEDIS Support

We have developed a program to help address our members' health care needs that align with HEDIS measures. Aetna Better Health of Virginia has partnered with mPulse to provide a digital solution for conducting outreach to members for care/service reminders and education. The goal of this program is to improve quality metrics, including HEDIS measures, as well as member health outcomes, via a digital communication solution that contacts the member via text message. Aetna provides all funding for this program. Therefore, there is no risk nor cost to providers who participate.

 

If you are interested in learning more and participating in the program, please reach out to our Quality Management department at QualityManagementPrograms@Aetna.com.

HEDIS Measurement Years 2022 Billing Codes Quick Reference Guide

 

(AAP) Access and availability of care (PDF)

 

(SAA) Adherence to antipsychotic medications for individuals with schizophrenia (PDF)

 

(AMB) Ambulatory care (PDF)

 

(AMM) Antidepressant medication management (PDF)

 

(CWP) Appropriate testing for pharyngitis (PDF)

 

(URI) Appropriate testing for upper respiratory infection (PDF)

 

(AMR) Asthma medication ratio (PDF)

 

(AAB) Avoidance of antibiotic treatment for acute bronchitis/bronchiolitis (PDF)

 

(BCS) Breast cancer screening (PDF)

 

(SMC) Cardiovascular monitoring for people with cardiovascular disease and schizophrenia (PDF)

 

(CCS) Cervical cancer screening (PDF)

 

(WCV) Child and adolescent well care visits (PDF)

 

(CIS) Childhood immunization status (PDF)

 

(CHL) Chlamydia screening in women (PDF)

 

(CBP) Controlling high blood pressure (PDF)

 

(DEV) Developmental screening in the first three years of life (PDF)

 

Diabetes care (PDF)

 

(SMD) Diabetes monitoring for people with diabetes and schizophrenia (PDF)

 

(FUH) Follow-up after hospitalization for mental illness (PDF)

 

(ADD) Follow-up care for children prescribed ADHD medication (PDF)

 

(IMA) Immunizations for adolescents (PDF)

 

(LSC) Lead screening in children (PDF)

 

(APM) Metabolic monitoring for children and adolescents on antipsychotics (PDF)

 

(PBH) Persistence of Beta-blocker treatment after a heart attack (PDF) 

 

(PDE) Pharmacotherapy management of COPD exacerbation (PDF) 

 

(PCR) Plan all-cause readmissions (PDF)

 

(PPC) Prenatal and postpartum care (PDF)

 

(PSC) Statin therapy for patients with cardiovascular disease (PDF)

 

(SPD) Statin therapy for patients with diabetes (PDF)

 

(WCC) Weight assessment and counseling for nutrition and physical activity for children/adolescents (PDF)

 

(W30) Well-child visits in the first 30 months of life (PDF)

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

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