Using HEDIS^® Measure Specifications

Health care organizations may use HEDIS measure specifications for internal, noncommercial purposes (e.g., for internal quality improvement activities) by purchasing the appropriate user-level license to HEDIS Volume 2 in the NCQA store. NCQA Measure Certification is not required for internal, noncommercial use. If a health care organization wants to publicize its HEDIS results, appropriate disclaimers must be used, as provided in the NCQA Store’s HEDIS Volume 2 license agreement.

Vendors and consultants that want to use HEDIS measure specifications for commercial purposes (further described below), or for any external reproduction, distribution or publication of measure specifications, must obtain a commercial-use license with NCQA. Use of a vendor or consultant’s measure logic may need to be validated through NCQA’s Measure Certification program.

Commercial use of HEDIS includes but is not limited to entities that offer products or services for:

• Closing gaps in care
• Population health activities
• Calculating measure rates for submission to external programs
• HEDIS medical record review
• Professional training related to HEDIS measurement and reporting
• Measure Interpretation and explanation
• Matching codes in data sources against the HEDIS VSD
• Use of Allowable Adjustments for HEDIS reporting

For more information and to obtain the appropriate license, contact NCQA through My.NCQA, select Ask a Question > Orders > Custom License Requests.

NCQA supports federal, state and public-sector entities’ use of HEDIS measure specifications in their programs. NCQA grants use of HEDIS measure specifications, including desired adjustments according to the Rules for Allowable Adjustments, for this purpose under an appropriate license. Public-sector entities using a third party to calculate HEDIS measure rates may be required to use an NCQA-Certified vendor or have their selected vendor achieve Measure Certification. For more information and to obtain the appropriate license, contact NCQA through My.NCQA, select Ask a Question > Orders > Custom License Requests.

• HEDIS Measure Specifications – Commercial and Non-Commercial
• HEDIS Medication List Directory (MLD)
• HEDIS Research Use Only (RUO)
• Align. Measure. Perform. Program. (AMP)

All uses of NCQA’s HEDIS measure specifications and any NCQA-owned and copyrighted intellectual property require entering into an appropriate license agreement with NCQA.

Retired measures are no longer maintained by NCQA or included in the HEDIS measurement set. Most retired measures may be used in products, programs and services under the appropriate custom license agreement.

NCQA has determined that certain measures are clinically inappropriate and may never be used. These measures may not be used in any product, program or service, and all use must stop:

• Management of Menopause Survey (retired 2005).
• Vaginal Birth After Cesarean Rates (retired 2005).
• Aspirin Use and Discussion (retired 2017).

The HEDIS Value Set Directory (HEDIS VSD), published as part of HEDIS Volume 2 and Volume 3, crosswalks HEDIS measure specifications to third-party medical and billing codes, including, but not limited to, CPT^® by the American Medical Association and Uniform Billing Codes by the American Hospital Association.

The HEDIS VSD is available to customers that purchase a license for HEDIS Volume 2 and Volume 3. Third-party codes in the HEDIS VSD may be protected under federal copyright laws and are included in HEDIS Volume 2 and Volume 3 with permission of the copyright owners. No right or license is given to use, reproduce, distribute, incorporate or display third-party codes. All uses of third-party codes may require a license, which users must obtain directly from the copyright owners. NCQA has no liability or responsibility for use of these third-party codes.

HEDIS VSDs and value sets may not be adjusted or used with third-party, non-HEDIS measures without explicit permission from NCQA via a custom license agreement. NCQA will evaluate the appropriateness of associating the value sets with third-party non-HEDIS measures and will provide an appropriate disclaimer, if approved.

If you suspect an organization is using the HEDIS measure specifications without a license or without the necessary NCQA Measure Certification, please call our reporting hotline.

NCQA’s confidential reporting hotline is set up through Lighthouse Services and is available to anyone who wants to report allegations that could affect NCQA-related operations, including but not limited to, the survey process, HEDIS measures and determination of NCQA status and level. Individuals may report by phone, email, fax or on line.

Toll-Free Telephone

• English-speaking USA and Canada: 844-440-0077 (not available from Mexico).
• Spanish-speaking North America: 800-216-1288.

Online: Lighthouse-Service.com/NCQA

Email: reports@lighthouse-services.com (must include NCQA’s name with report).

Fax: 215-689-3885 (must include NCQA’s name with report).