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Using HEDIS® Measure Specifications

NCQA supports the broad use of the HEDIS® measure specifications to evaluate and drive health care quality.

We believe that inconsistent measurement leads to wasted resources and missed opportunities. It is our priority to ensure that all HEDIS uses are covered under the appropriate license agreement and that accurate HEDIS measure specification results are calculated.

Permitted Uses of HEDIS

NCQA works with health care organizations, vendors, consultants and federal and state entities that want to incorporate HEDIS measure specifications in their products, programs or services. All uses of NCQA’s HEDIS measure specifications, and any NCQA-owned and copyrighted intellectual property, require an appropriate license agreement with NCQA. The license agreement will address the intended use of the HEDIS measure specifications, including compliance with the Rules for Allowable Adjustments and completing NCQA’s Measure Certification program, if applicable. License fees, if any, are based on use of HEDIS measure specifications.

Health Care Organizations

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

Vendors and consultants that want to use HEDIS measure specifications for commercial purposes (e.g., offer products or services for closing gaps in care, population health activities, calculate measure rates for submission to external programs ), 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. For more information and to obtain the appropriate license, contact NCQA through My.NCQA, select Ask a Question > OrdersCustom License Requests.

 

Public Sector Stakeholders

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 a custom, no-cost 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 > OrdersCustom License Requests.

 

Prohibited Use of HEDIS

Certain uses of HEDIS and HEDIS-related materials are prohibited.

 

Unlicensed Use

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.

 

Use of Retired Measures

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).

 

Using the HEDIS Value Set Directory

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.

 

Unlicensed/Uncertified Uses of HEDIS

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).

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