December 9, 2020
Two behavioral health tip sheets have been added to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code claims appropriately:
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
- Use of Opioids from Multiple Providers (UOP)
These measures from the National Committee for Quality Assurance (NCQA) serve as quality improvement tools to help ensure our members receive appropriate care.
The tip sheets usually include measurement requirements, best practices and billing codes.
APM Measure
Document metabolic testing for members ages 1 to 17 years old who were dispensed two or more antipsychotic medications within a year. If the medications are dispensed on different dates, even if it’s the same medication, test both blood glucose and cholesterol levels.
UOP Measure
This measure evaluates members 18 years and older who were dispensed an opioid for 15 days or more from multiple prescribers and/or pharmacies. Three rates are reported. The proportion of members dispensed opioids from four or more different prescribers, four or more different pharmacies and from a combination of four or more different prescribers and four or more different pharmacies.
*Measurement Year (MY) 2020 and MY 2021
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.