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Medicaid (BCCHP/MMAI)

Blue Cross and Blue Shield of Illinois (BCBSIL) collects Healthcare Effectiveness Data and Information Set (HEDIS®) data from our providers to measure and improve the quality of care our members receive.

Each year, BCBSIL reports audited HEDIS results for Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM. These results 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). 

For current year (CY) 2019/HEDIS 2020, BCCHP and MMAI hybrid measures were impacted by the COVID-19 pandemic. As a result, BCBSIL’s ability to collect medical record data was disrupted. Health plans will still be seeing the impact of the pandemic into CY 2020/HEDIS 2021.

Of the 26 HEDIS rates for BCCHP that were comparable to goals, eight (8) rates met NCQA Quality Compass® National goals. Seven (7) rates showed statistically significant improvements from the previous year. The Utilization HEDIS measures and first year measures were not included in the comparison. 

View the 2020 BCCHP HEDIS results 

Of the 35 HEDIS rates for MMAI that were comparable to goals, fifteen (15) rates met either national standards or State/CMS goals, while ten (10) rates demonstrated statistically significant improvements from the previous year. Utilization HEDIS measures and first year measures were not included in the comparison. 

View the 2020 MMAI HEDIS results 

Resources for Providers

As part of the effort to improve the quality of care our members receive, BCBSIL has created HEDIS tip sheets and billing guides to serve as resources for our providers who are looking for general information on the HEDIS measurement requirements and medical record best practices and billing codes. Compliance with HEDIS measures and proper coding and documentation reduces the need for providers to send medical records later for review.

The following resources have been developed to assist providers in ensuring compliance with HEDIS measures:

HEDIS 2020 Billing Codes

Tip Sheets

Behavioral Health Tip Sheets

CAHPS Resources

Additional Resources for Providers (non-HEDIS)

HEDIS is a registered trademark of NCQA.