Behavioral Health HEDIS® Tip Sheets
Blue Cross and Blue Shield of Illinois (BCBSIL) created tip sheets to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code appropriately. These measures from the National Committee for Quality Assurance (NCQA) help ensure our members receive appropriate care.
Compliance with HEDIS measures reduces the need for you to send medical records later for review. The tip sheets include measurement requirements, medical record best practices and billing codes for all our members including, all fully-insured PPO, Blue Choice PPOSM and HMO, Blue Cross Community Health PlansSM (BCCHPSM), Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Medicare Advantage members.
- Children ages 6 to 12
- Newly1 filled attention-deficit hyperactivity disorder (ADHD) medication
- Prescribed in the ambulatory setting
- Members ages 18 and older
- Diagnosed with major depression
- Newly2 filled antidepressant medication
- Members ages 6 and older
- Discharged from an acute inpatient hospital stay
- Principal diagnosis at discharge is mental illness or intentional self-harm
- Outpatient follow-up visits must be with a mental health provider3 (includes telehealth visits) or in certain outpatient4 settings
- Members ages 13 and older
- Newly5 diagnosed with alcohol or other drug (AOD) abuse or dependence
- Treatment may occur in the inpatient, residential, outpatient,6 medication-assisted treatment (MAT) or telehealth setting
- Members ages 18 to 64
- Diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder
- Received an antipsychotic medication at any time during the year
1Defined as no ADHD medication filled in past 120 days
2Defined as no antidepressant medication filled in past 105 days
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.