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HEDIS

HEDIS®1 is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need for reliable comparison of health plan performance. HEDIS measures relate to many significant public health issues, such as cancer, heart disease, and diabetes. NCQA2 updates HEDIS every year.

Small steps make a difference
Here are some ideas for increasing HEDIS scores.
  • Conduct and bill a well visit with a sick visit for a member who has not had their routine physical.
  • Contact patients who have not had routine or preventive services. We provide template language for you to use.
  • Be sure that follow-up instructions are clear and documented in the medical record.

HEDIS scores are used by:

  • Providers to identify gaps in care or other opportunities for improvement.
  • Health plans to ensure positive member health outcomes. These scores help to direct our quality initiatives, including incentive programs and education for clinicians and members.

Demonstrating quality together

Health plans seek accreditation from NCQA as a sign of their commitment to quality standards. We earn this recognition in partnership with you, our providers. We ask you to:


Document in the medical record all the care you provide to our members. Medical records provide a level of detail not always captured in claims.
  • Consider granting Blue Cross direct access to your electronic medical records (EMR) for HEDIS-specific information only. If you have questions about remote EMR access, please contact Ankita Desai at 1-617-246-6577.
  • Please respond to our medical record requests within three weeks.

Accurately code all claims (see our Coding Tip Flashcards).

Know your HEDIS measures documentation requirements; refer to the HEDIS at a Glance we send providers annually.

Read our current HEDIS articles.

Document in the medical record all the care you provide to our members. Medical records provide a level of detail not always captured in claims.
  • Consider granting Blue Cross direct access to your electronic medical records (EMR) for HEDIS-specific information only. If you have questions about remote EMR access, please contact Ankita Desai at 1-617-246-6577.
  • Please respond to our medical record requests within three weeks.

Accurately code all claims (see our Coding Tip Flashcards).

Know your HEDIS measures documentation requirements; refer to the HEDIS at a Glance we send providers annually.

Read our current HEDIS articles.

Many of our provider contracts include HEDIS-based incentives that offer the potential to increase reimbursement while ensuring members are receiving optimal care.

NCQA Health Plan Ratings

The NCQA creates annual report cards for approximately 1,400 health plans. Ratings are based on the plans’ combined HEDIS, CAHPS® and NCQA Accreditation standards scores.

View our NCQA report card.

The methodology used for NCQA Health Plan Ratings is similar to the methodology used for Medicare Part C and D Star Ratings.


1. HEDIS is an abbreviation for Healthcare Effectiveness Data and Information Set. The first HEDIS measures were designed by the NCQA (National Committee for Quality Assurance) in 1991.

2. NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the performance measurement tool used by more than 90 percent of the nation’s health plans.