Quality resources for providers
Like you, we work to continually improve the quality of our services for the members who entrust us with their care. Here you will find resources to help us work together to improve healthcare quality for the members who need it most.
HEDIS® measures
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. HEDIS measures and specifications are published by the National Committee for Quality Assurance (NCQA) to help objectively evaluate and compare performance and quality across health plans, including Medicare, Medicaid and commercial plans.
HEDIS includes more than 80 measures which are aggregated to rate the effectiveness of care, member experience, and the appropriate coding of care received. Learn more in our HEDIS General Guidelines.
HEDIS tip sheets
The tip sheets below can be used to help you improve on select HEDIS measures.
Additional resources
- HEDIS General Guidelines MY 2024
- HEDIS measures (NCQA)
- HEDIS billing and coding guide (CMS)
- List of CPT/HCPCS codes (CMS)
- CPT® codes (AMA)
Helpful resources
- HEDIS measures (NCQA)
- WellSense HEDIS billing and coding guide
- WellSense 2023 HEDIS summary report
Quality rating programs
Best practices
We've compiled a list of resources below to help you follow best practices when it comes to patient care.
- Preventing falls in older adults
- Catch up on routine childhood vaccines
- Tips to improve immunizations for adolescents (IMA)
- Managing asthma this allergy season
- Medicare annual wellness visits
Latest news
Read our latest provider newsletters or visit the archive to find older issues.
- Understanding the HEDIS Eye Exam for Patients with Diabetes (EED) measure
- HEDIS Initiation and Engagement of Substance Use Disorder Treatment (IET)
- HEDIS Follow-Up After Emergency Department for Mental Illness (FUM) measure tips
- Health outcomes survey (Senior Care Options)
- Health outcomes survey (New Hampshire Medicare Advantage)
- HEDIS Diabetic Measures Update
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