August 7, 2020
We’ve created two new behavioral health 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 HMO, Blue Cross Community Health PlansSM (BCCHPSM), Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Medicare Advantage members.
- 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 behavioral health provider1 (includes telehealth visits) or in certain outpatient2 settings
- Members ages 13 and older
- New3 diagnosis of alcohol or other drug (AOD) abuse or dependence
- Treatment may occur in the inpatient, residential, outpatient,4 medication-assisted treatment (MAT) or telehealth setting
*Measurement year 2020 and measurement year 2021
1Psychologist, Psychiatrist, Clinical Social Worker, Mental Health Occupational Therapist, Psychiatric/Mental Health Nurse Practitioner/Clinical Nurse Specialist, Neuropsychologist, Psychoanalyst, Professional Counselor, Marriage and Family Therapist
2Community mental health center, electroconvulsive therapy, transitional care management services and includes intensive outpatient or partial hospital programs
3Defined as no diagnosis of AOD abuse or dependence in previous 60 days
4Outpatient treatment includes an intensive outpatient or partial hospital program
HEDIS is a registered trademark of the 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.