FAQ Directory: HEDIS

Filter Results
  • Save

    Save your favorite pages and receive notifications whenever they’re updated.

    You will be prompted to log in to your NCQA account.

  • Email

    Share this page with a friend or colleague by Email.

    We do not share your information with third parties.

  • Print

    Print this page.

4.15.2024 SNS-E Numerator Criteria for Completed Screenings For screening indicators, which responses to screening questions meet numerator criteria?

Any coded response (i.e., any non-null response—positive or negative) on a pre-specified instrument for food, housing and transportation counts for completed screening numerators (numerators 1, 3, 5). The PRAPARE Food Insecurity Instrument question (LOINC code 93031-3) is an exception. Based on how the question is structured and responses are coded, a “No” or “None of the above” response cannot be coded and must be left null. Therefore, a null response meets criteria for this item only. 


3.18.2024 HEDIS MY 2023 Audit Timeline Modifications Does the recent guidance issued by NCQA on HEDIS MY 2023 audit timeline modifications apply to all organizations?

No. If the medical record review retrieval and/or abstraction operations for HEDIS MY 2023 reporting of your organization were not impacted by the Change Healthcare cyberattack, then the timeline modifications do not apply to you. You must follow the HEDIS MY 2023 Audit Timeline published on NCQA.org.
Affected organizations (defined above) should work with their auditor on HEDIS MY 2023 timeline modifications. All HEDIS Compliance Audit Licensed Organizations will share this information with the relevant organizations.



2.15.2024 Indication of an FOBT Test for the Colorectal Cancer Screening Measure Is documentation of “Colon Screening,” “Colon Screen” or “Colorectal Cancer Screening” sufficient to be considered an FOBT if it was completed during the measurement year?

Yes. Documentation of “Colon Screening,” “Colon Screen” or “Colorectal Cancer Screening,” with screening dates during the measurement year, could indicate an FOBT, the least invasive test that would use this limited documentation.


2.15.2024 Compliant Documentation of Colonoscopy for the Colorectal Cancer Screening Measure Is documentation of “c-scope," “colo” or “colon” sufficient to be considered a colonoscopy?

No. Documentation of “c-scope,” “colo” or “colon” alone is not specific enough to be considered evidence of a colonoscopy.


2.15.2024 Use of Continuity of Care Documents (CCDs) Can CCDs from health information exchanges be used for medical record review?

No. The medical record review process for the hybrid data collection methodology requires that information be abstracted from the medical record. CCDs are not the same as the medical record; this includes CCDs received from health information exchanges. Note that because electronically exchanged CCDs may be used as supplemental data, they are subject to supplemental data requirements.


2.15.2024 Provider Interaction with Admission/Discharge Information in the Medical Record for the Transitions of Care Measure For the Notification of Inpatient Admission and Receipt of Discharge Information indicators, is evidence that the provider reviewed the admission/discharge information required (i.e., is the provider required to sign or acknowledge the admission/discharge information after it is filed in the outpatient medical record)?

No. Evidence that the PCP or ongoing care provider reviewed the admission/discharge information is not required for these indicators. If the required information is filed in the outpatient medical record or shared EMR (accessible to the PCP or ongoing care provider) during the required time frame, this alone meets criteria.


2.15.2024 ADT Feeds for the Transitions of Care Measure Does an admission notification documented in an ADT feed meet criteria for the Notification of Inpatient Admission and Receipt of Discharge Information indicators?

No. Admission/discharge notifications in the ADT alone do not meet criteria (even if the provider has access to the ADT) because ADTs are not considered the legal medical record.
Criteria are met if the provider documents ADT notifications in the appropriate outpatient medical record or shared EMR (accessible to the PCP or ongoing care provider) during the time frame specified in the measure.


2.15.2024 FI-SNPs, HI-SNPs, IE-SNPs and HEDIS Reporting Are Facility-Based Institutional SNPs (FI-SNPs), Hybrid Institutional SNPs (HI-SNPs) and Institutional Equivalent-SNPs (IE-SNPs) treated the same as I-SNPs when reporting HEDIS?

Yes. FI-SNPs, HI-SNPs and IE-SNPs should be treated the same as I-SNPs for reporting. Because they are all types of I-SNPs, they are included in the I-SNP exclusion, and are excluded when
I-SNPs are excluded.


1.16.2024 3-Dose-Series Prevnar 20 Pneumococcal Vaccine for Childhood Immunization Status (CIS) When will PCV20 pneumococcal vaccine be added to the pneumococcal conjugate value sets?

We anticipate that PCV20 will be added to the CIS value sets in the HEDIS MY 2024 Technical Update, scheduled for release on April 1, 2024.
Although the PCV20 vaccine is not included in the measure for MY 2023, NCQA does not anticipate this will impact performance. The measure denominator only includes children who were at least 18 months old and expected to have already completed the pneumococcal series by June 2023 (the month when ACIP recommended PCV20).


11.16.2023 MY 2023 Race and Ethnicity Stratification (RES) HEDIS Compliance Audit Requirements Are there new audit requirements for race and ethnicity stratification reporting for MY 2023?

No. Volume 5: HEDIS Compliance Audit MY 2023 does not include new requirements for reporting race and ethnicity. Consistent with MY 2022, these data are addressed in the HEDIS Roadmap. Auditors must confirm that organizations provide a complete Roadmap response, and review all attachments describing data flow, layout and transformation. Roadmap Section 6, Question 6.3J requires organizations to describe the sources they use, their processes for disaggregating race and ethnicity fields, their data source reconciliation and prioritization processes and the percentage of members with available data.  

NCQA introduced a direct data threshold of ≥20% for Race/Ethnicity Diversity of Membership (RDM) in the 2024 Health Plan Ratings scoring methodology. Please note that this is independent from the race and ethnicity stratifications, and should not impact audit designations. There are no bias thresholds for the race and ethnicity stratifications in Volume 5.


11.16.2023 Sources with populated race or ethnicity values of “Unknown” or “Two or More Races” How should organizations handle data sources with values of “Unknown” or “Two or More Races”?”

NCQA strongly discourages using “Unknown” and “Two or More Races” response categories when collecting race and ethnicity data. When possible, organizations should instead use and encourage alternatives such as: 

  • “Other” or “None of the above” response options for members who are unsure of their race or ethnicity. 

  • The ability to select multiple race values for members with two or more races. 

If “Unknown” or “Two or More Races” are populated values in sources where health plans cannot improve response terms/options, they can be mapped to the “Some Other Race” reporting category. 


11.16.2023 Data source for “Asked But No Answer” reporting category To what data source should organizations attribute the “Asked But No Answer” race and ethnicity reporting category?

The “Asked But No Answer” reporting category reflects members who were asked for race or ethnicity data, but who declined to provide a response. This reporting category must be attributed to a direct data source because the members self-reported by declining to answer.