August 23, 2021
The National Committee for Quality Assurance (NCQA) has developed Healthcare Effectiveness Data and Information Set (HEDIS) measures as a tool for performance improvement. We collect HEDIS data from our contracted providers to measure and improve the quality of care our members receive.
The NCQA recommends tracking annual dental visits with a dental practitioner, a HEDIS measure, for our members between the ages of 2 and 20 years of age, as of December 31 of the measurement year.
Please refer our members to a participating, qualifying dental provider, if they don’t already have one. Once the dental provider submits our member’s claim, the HEDIS annual dental visit will be documented.
HEDIS measure requirements:
- A dental visit must be completed by December 31 of the measurement year
- Chart documentation should include the date of services for the annual dental visit
Dental visit must be completed by a dental practitioner, which is defined as:
- Doctor of Dental Surgery (DDS)
- Doctor of Dental Medicine (DMD)
- Certified & Licensed Dental Hygienist
According to the American Academy of Pediatric Dentistry (AAPD), tooth decay can be prevented and even reversed. The AAPD makes the following recommendations you can share with patients:
- Establish a dental home; have an ongoing relationship between a pediatric dentist, if available, and patient family that includes all aspects of oral health1
- Find your dental home no later than your child’s first birthday or when their first tooth appears and no later than 12 months of age1
- Brush your child’s teeth for two minutes, two times a day, and floss as soon as the teeth start touching1
- Supervise your young child’s toothbrushing2
1 American Academy of Pediatric Dentistry. (n.d.) A National Children’s Dental Health Month Letter from AAPD President Dr. Donly. https://mouthmonsters.mychildrensteeth.org/a-national-childrens-dental-health-month-letter-from-aapd-president-dr-donly/
2 U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Dental and Craniofacial Research, National Call To Action To Promote Oral Health, 2003. https://www.ncbi.nlm.nih.gov/books/NBK47472/
HEDIS is a registered trademark of the NCQA.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.