HEDIS

What is HEDIS®?

HEDIS® is a tool to measure heath plans’ performance.

What does HEDIS® stand for?

H=HEALTHCARE
E=EFFECTIVENESS
D=DATA
I=INFORMATION
S=SET

What does it measure?

Health plans’ performance during the prior calendar year. HEDIS® measures are reported annually for the following areas:

  • Effectiveness of Care assesses the delivery of preventive services and services related to chronic disease (e.g., mammography screening, dilated retinal exam).
  • Access/Availability of Care assesses the availability of health care to plan members.
  • Satisfaction with the Experience of Care measures member satisfaction.
  • Healthcare Plan Stability assesses practitioner turnover and total membership.
  • Use of Service addresses utilization measures, such as discharge rates and average length of stay.
  • Healthcare Plan Description Information addresses how the health plan is organized and the number and types of participating physicians.
  • Cost of Care
  • Informed health care choices

For more information about HEDIS, please call 1-800-953-8854.

2017 HEDIS Provider Billing Guide