HEDIS FAQs

HEDIS Measures and Technical Resources

191 million people are enrolled in plans that report HEDIS results. That makes HEDIS one of health care’s most widely used performance improvement tools. HEDIS includes measures for physicians, PPOs and other organizations. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through My NCQA.

CAHPS 5.1H Survey Updated Fall 2020

  • Reflects increased use of telehealth.
  • Revises some questions to include phone and video visits.
  • Uses wording tested with consumers.
  • Will be part of Health Plan Accreditation—as CAHPS has been for years.

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HEDIS Measures

HEDIS® measures performance in health care where improvements can make a meaningful difference in people’s lives.

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Effectiveness of Care

Prevention and Screening

Respiratory Conditions

Cardiovascular Conditions

Diabetes

Musculoskeletal Conditions

Behavioral Health

Medication Management and Care Coordination

Overuse/Appropriateness

Measures Collected Through the Medicare Health Outcomes Survey

Measures Collected Through the CAHPS® Health Plan Survey

Access/Availability of Care

Utilization

Risk Adjusted Utilization

Measures Reported Using Electronic Clinical Data Systems

HEDIS Technical Resources

HEDIS Technical Specifications include a complete list of new and updated HEDIS measures with instructions on data collection and guidelines for calculations and sampling.

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HEDIS Measurement Year 2022

Vol. 1: Narrative

Overview of the HEDIS measurement set and how the data are used.

Vol. 2: Technical Specifications for Health Plans

HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.

HEDIS Measures Included in the Quality Rating System (QRS)

Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).

Technical Specifications for ACO Measurement

HEDIS quality measures for Accountable Care Organizations.

Vol. 3: Specifications for Survey Measures

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program.

Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.

  • Order this publication (anticipated release date: October 2022)
  • HEDIS Compliance Audit
  • Specification Updates (anticipated release date: December 2022)
  • HEDIS MY 2022 Audit Timeline (anticipated release date: March 31, 2022)

Vol. 6: The Medicare Health Outcomes Survey Manual

Technical specifications for the Health Outcomes Survey (HOS).

HEDIS Technical Specifications for Long-Term Services and Support Measures

The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).

HEDIS Measurement Year 2021

Vol. 1: Narrative

Overview of the HEDIS measurement set and how the data are used.

Vol. 2: Technical Specifications for Health Plans

HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.

HEDIS Measures Included in the Quality Rating System (QRS)

Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).

Technical Specifications for ACO Measurement

HEDIS quality measures for Accountable Care Organizations.

Vol. 3: Specifications for Survey Measures

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program.

Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.

Vol. 6: The Medicare Health Outcomes Survey Manual

Technical specifications for the Health Outcomes Survey (HOS).

HEDIS Technical Specifications for Long-Term Services and Support Measures

The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).

HEDIS Measurement Year 2020

Vol. 1: Narrative

Overview of the HEDIS measurement set and how the data are used.

Vol. 2: Technical Specifications for Health Plans

HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.

HEDIS Measures Included in the Quality Rating System (QRS)

Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).

Technical Specifications for ACO Measurement

HEDIS quality measures for Accountable Care Organizations.

Vol. 3: Specifications for Survey Measures

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program.

Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.

Vol. 6: The Medicare Health Outcomes Survey Manual

Technical specifications for the Health Outcomes Survey (HOS).

HEDIS Technical Specifications for Long-Term Services and Support Measures

The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).

HEDIS Archives

HEDIS 2020 (Measurement Year 2019)

HEDIS 2019 (Measurement Year 2018)

Rules for Allowable Adjustments of HEDIS

Recognizing that HEDIS measures have traditionally been specified for health plan reporting, NCQA developed the Rules for Allowable Adjustment of HEDIS to accommodate the application of HEDIS measures to various levels of the health care system for quality improvement initiatives. The rules provide flexibility for evaluating different populations without altering measures’ clinical intent (e.g., removal of continuous enrollment or product-line criteria).

The Rules for Allowable Adjustments are included in the HEDIS Volume 2 publication after the applicable HEDIS measure specifications. NCQA’s HEDIS Value Set Directory (VSD) includes the necessary third-party codes for use with adjusted measure specifications.

HEDIS FAQ

Visitors to this page often check HEDIS FAQs or ask a question through MyNCQA.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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