Medicaid (BCCHP/MMAI)

Blue Cross and Blue Shield of Illinois collects data annually from our providers as part of the Healthcare Effectiveness Data and Information Set (HEDIS®). This effort measures the quality of care our members receive and is used to improve their health care. The HEDIS results for Blue Cross Community Health PlansSM and Blue Cross Community MMAISM are sent to the Illinois Department of Healthcare and Family Services (HFS), Centers for Medicare & Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA).

The performance measures represent data from measure year 2022, reflecting the measurement year timeframe from Jan. 1, 2022, to Dec. 31, 2022. The BCCHP HEDIS rates are compared to the 2023 NCQA Quality Compass Medicaid Percentiles. The MMAI HEDIS rates are compared to the 2022 NCQA Quality Compass Medicare Percentiles. For BCCHP, HEDIS rates were reported for 40 HEDIS measures or sub-measures. Of those measures, twenty rates exceeded the NCQA 50th percentile benchmark. Six rates exceeded the NCQA 75th percentile benchmark, and one rate exceeded the NCQA 90th percentile benchmark. MMAI reported 51 HEDIS measures or sub-measures. Of the 51 measures or sub-measures, 16 rates exceeded the NCQA 50th percentile benchmark and five rates exceeded the NCQA 75th percentile benchmark.

Resources for Providers

It is important that as care is given to members the services rendered are documented and billed correctly to reflect the care given. As part of the effort to improve the quality of care our members receive, BCBSIL has created HEDIS Tip Sheets to serve as resources for our providers who are looking for general information on the HEDIS measurement requirements. Compliance with HEDIS measures and proper coding and documentation reduces the need for providers to send medical records later for review. Email questions or requests for additional information.

HEDIS is a registered trademark of NCQA.