September 2019
HEDIS® 2020 Updates and Your Role in Impacting HEDIS Results
Review the most recent changes to the technical specifications regarding documentation (includes this year and the most recent years):
Measure(s) |
Changes |
W15, W34, and AWC |
Notations of “well-developed/nourished/appearing,” “appropriate for age” without mention of development, “appropriately responsive for age” or “neurological exam” are not sufficient for the assessment of mental and physical development. |
W15, W34, and AWC |
The Tanner Stages may be used only to document physical development for AWC. |
W15, W34, and AWC |
Services provided via telehealth do not count. |
W15, W34, AWC, and WCC |
Handouts given during a visit without evidence of a discussion, or information regarding medications or immunizations or their side effects does not meet criteria for Health Education/Anticipatory Guidance. Acceptable documentation for well child visits includes: “age appropriate anticipatory guidance discussed” or “the following items were provided and discussed today: car safety (use age appropriate seat, avoid air bags, use back seat)” |
WCC |
A referral to WIC may be used to meet criteria for Counseling for Nutrition. |
PPC |
Eligibility timeframe changed from November to October (HEDIS 2020 = 10/8/2018 to 10/7/2019) Prenatal Care visits that occur in the first trimester on or before the enrollment start date or within 42 days of enrollment are allowed. Post-partum visits between 7 and 84 days after delivery are allowed. |
Best Practices – What Is Your Role in HEDIS?
- Provide the appropriate care within the designated time frames
- Document all care in the patient’s medical record and ensure that two identifiers are on every page of the medical records (visit notes, assessments, handouts, etc.)
- Accurately code all claims; providing accurate information on a claim may reduce the number of records requested
- Know the documentation requirements and specific parameters for your HEDIS measures
- Respond to our requests for medical records within 5 to 7 business days
Resources
Reference and review BCBSTX’s Preventive Care Guidelines and Clinical Practice Guidelines, and the Texas Health Steps for Providers website
for more information on this and other important topics for treating your patients.
HEDIS is an independent company that provides analytics to Blue Cross and Blue Shield of Texas. HEDIS is a registered trademark of NCQA.