April 16, 2026
We track Healthcare Effectiveness Data and Information Set (HEDIS®) measures related to prenatal and postpartum care visits and depression screening to help ensure our members receive appropriate care. To support quality care, we encourage you to talk with our members about attending all care visits during and after pregnancy. Learn more about the measures below, as well as tips to close gaps in members’ care.
Prenatal quality measures
- Prenatal care measures the percentage of deliveries in which members had a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment with Blue Cross and Blue Shield of Illinois.
- Prenatal depression screening and follow-up measures the percentage of deliveries in which members were screened for clinical depression during pregnancy using a standardized instrument and received follow-up care within 30 days if the screening was positive.
Postpartum quality measures
- Postpartum care measures the percentage of deliveries in which members had a postpartum visit on or between seven and 84 days after delivery.
- Postpartum depression screening and follow-up measures the percentage of deliveries in which members were screened for clinical depression during postpartum period using a standardized instrument and received follow-up care within 30 days if the screening was positive.
Tips to close gaps in prenatal care
- Data for prenatal care measures is collected from claims and chart review for prenatal services performed by an OB-GYN, midwife, family practitioner or other PCP. Services provided during telehealth visits, e-visits and virtual check-ups are eligible for reporting to meet the measure.
- Check with our members to ensure that initial prenatal visits are scheduled within 14 weeks of gestation with an OB-GYN, primary care provider or other prenatal practitioner.
- Ultrasound and lab results alone aren’t considered a visit for the prenatal care measure. The results must be combined with an office visit with an appropriate practitioner.
- A pap test doesn’t count as prenatal care for this measure.
Tips to close gaps in postpartum care
- Data for postpartum care measures is collected from claims and chart review for postpartum services performed by an OB-GYN, midwife, family practitioner or other PCP. Services provided during telehealth visits, e-visits and virtual check-ups are eligible for reporting to meet the measures.
- A postpartum visit must take place on or between seven and 84 days after delivery. Be aware that post-operative visits within six days after discharge don’t count as a postpartum visit. Members who have cesarean sections should be reminded to schedule their postpartum care visit during the C-section post-op visit.
Tips to close gaps in depression screening and follow-up
- Perform an age-appropriate depression screener, such as the Patient Health Questionnaire (PHQ)-9 or -2, or the Edinburgh Postnatal Depression Scale, during a member’s pregnancy and postpartum care.
- If the depression screening is positive, follow up within 30 days with one or more of the following, as appropriate:
− Additional evaluation for depression
− Suicide risk assessment
− Referral to a practitioner qualified to diagnose and treat depression
− Pharmacological interventions
− Other interventions or follow-up for the diagnosis or treatment of depression
- Coordinate care between behavioral health and other health care providers.
Provider resources
- Quality Care 2026, a resource with documentation and coding information for HEDIS measures, is available in Availity® Essentials in our payer space.
- Preventive Care Guidelines for providers
- Behavioral Health Clinical Practice Guidelines for providers
- Earn continuing education credit through our webinar on maternal mental health. Sign in here (registration required) to access the recording.
- Watch our video for providers on prenatal and postpartum depression screening.
Resources to share with members
- Perinatal Wellness Guidelines
- Video for members on prenatal and postpartum depression screening
- Information about Maternity Care Centers and Special Beginnings®, our maternity program for members that supports early identification of pregnancy risk factors, education and help managing high-risk conditions
HEDIS is a registered trademark of the National Committee for Quality Assurance.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.
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.