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.
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.
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
- BCCHP Codes that Correspond to the HEDIS Quality Measures
- MMAI Codes that Correspond to the HEDIS Quality Measures
- Breast Cancer Screening
- Care for Older Adults
- Child and Adolescent Health
- Chronic Conditions
- Controlling Blood Pressure
- Transitions of Care
- Women’s Health
Behavioral Health Tip Sheets
- 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
- Treatment for Alcohol and Other Drugs
- 2021 CAHPS Survey Overview
- ALERT Communication Model
- Benefits of Nurse Advice Line and Interpreter Services
- CAHPS Checklist to Improve Survey Results
- Medical Appointment Standards for Illinois Medicaid
Additional Resources for Providers (non-HEDIS)
- ICD-10 Z Codes for Social Determinants of Health
- Medicaid (BCCHP) Key Contacts for Providers
- Medicaid (MMAI) Key Contacts for Providers
- Transportation Services for Medicaid Members
HEDIS is a registered trademark of NCQA.