FAQ Directory: HEDIS

Only the LTI flag in the Monthly Membership Detail Data File may be used when identifying this exclusion. No other data sources may be used.

HEDIS MY 2025

Yes. Organizations may use the same sample for all measures, the same sample for two measures and a different sample for the third measure, or different samples for the three diabetes measures (GSD, EED, BPD).

HEDIS MY 2024

No. Although the Asthma Controller and Reliever Medication List includes RxNorm codes, they should not be used to identify dispensing events for this required exclusion. Only use pharmacy data (NDC codes) when assessing asthma controller or reliever medication dispensing events for this required exclusion. Because a dispensing event is required to calculate the numerator, members who had no dispensing events should be removed from the measure.

HEDIS MY 2024

Yes, as described in the Guidelines for Risk Adjusted Utilization Measures, organizations must use the Inpatient Stay Value Set for the risk adjustment comorbidity category determination (use the Inpatient Stay Value Set to identify acute and nonacute inpatient discharges with a discharge date during the classification period). The value set was mistakenly deleted from the EDH measure in the VSD. Because the guidelines clearly state that the value set must be used, NCQA does not intend to reissue the VSD.

HEDIS MY 2024

Yes, as described in the Required exclusions section of the CCS measure, use LOINC code 76689-9 to exclude members with a sex assigned at birth of male any time in the patient’s history. The code was mistakenly removed from the CCS measure in the 4-1-2024 release of the VSD (Direct Reference Code spreadsheet). Because the information needed for reporting is in the measure specification NCQA does not intend to reissue the VSD.

HEDIS MY 2024

When only a single code exists for a service or condition, it is included directly in the measure specification, and referred to as a Direct Reference Code (DRC). It is a best practice to not create value sets that include only a single code; some code systems prohibit this because it results in assigning another code (an OID) to a concept that already has a code.
DRCs are listed in the measure specifications and in a Direct Reference Codes spreadsheet in the value set directory.
For MY 2024, a number of single code value sets were converted to DRCs. The Summary of Changes – Value Sets spreadsheet indicates the value set was deleted. The Summary of Changes – Codes spreadsheet indicates the code was added as a DRC (filter Column A on “Direct Reference Code”).

HEDIS MY 2024

The numerator criterion is an eGFR and a uACR any time during the measurement year. These separate tests may occur on different dates.
The 4-day proximity language is specific to a reporting option for uACR, where a quantitative urine albumin test and a urine creatinine test may be billed separately. In practice, the quantitative urine albumin and urine creatinine tests are performed on the same date, from the same urine sample, to produce a single ratio. The 4-day proximity language intends to account only for potential billing lags between the separate quantitative urine albumin and urine creatinine administrative codes that indicate a single uACR evaluation; it is not intended for separate samples from different dates.

HEDIS MY 2024

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. 

HEDIS MY 2024

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.

HEDIS MY 2023

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.

HEDIS MY 2023

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

HEDIS MY 2023

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.

HEDIS MY 2024