Member-reported data are allowed in specific scenarios, and when all requirements are met.
Organizations may not call members to collect HEDIS data. The expectation is that member-reported data are generated during an encounter where the member receives care.
Some HEDIS data are reported by members; for example, when standardized assessment tools are used (e.g., PHQ-2), or when documenting language preference, race and ethnicity.
Services and biometric values reported by members are permitted if they adhere to the following guidelines in HEDIS Volume 2:
- Member-Reported Services and Biometric Values general guideline. Member-reported services may be used if collected by a PCP or specialist (if the specialist is providing a primary care service related to the condition being assessed, in the course of taking a member’s history), and if the information is in the member’s health record.
- Supplemental Data general guideline.
Information on services reported by members often reside in non-standard supplemental sources. The supplemental data general guideline states that there must be evidence of provider accountability for the information documented. Documentation of member-reported services must be complete (date, place of service, procedure, prescription, test result or finding, practitioner type).