HEDIS Toolkits
Texas Children’s Health Plan is proud to offer Healthcare Effectiveness and Data Information Set (HEDIS) Toolkits that contain helpful information regarding the measure requirements, standards and codes to use that are acceptable for HEDIS reporting. These toolkits will serve as a reference form that can be used to code the type of appointments made and ensure that all of the HEDIS standards are met. By using these toolkits, providers can streamline their reporting processes, reduce administrative burden and continue to provide high quality care to our members.
We are excited about the benefits these tools will provide for you and the outcomes it will drive for our members. We encourage you to explore the toolkits below and begin using them today to enhance your practice.
Behavioral Health
- Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
- Follow-Up After Emergency Department Visit for Substance Use (FUA)
- Follow-Up After Hospitalization for Mental Illness (FUH)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E)
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
Disease Management
Prevention and Screening
- Adults Access to Preventative Ambulatory Health Services (AAP)
- Child & Adolescent Well-Care Visits (W30, WCV)
- Childhood Immunization Status (CIS-E) Combination 10 (CO10) and Lead Screening in Children (LSC-E)
- Immunizations for Adolescents (IMA-E)
- Respiratory Conditions and Antibiotic Stewardship (AAB, AXR, CWP, URI)
- Social Needs Screening and Intervention (SNS-E)
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children & Adolescents (WCC)
Women/Maternal Health
- Cervical Cancer Screening (CCS-E)
- Chlamydia Screening in Women (CHL)
- Prenatal and Postpartum Care (PPC-PPC, TOPC)
HEDIS Data Reporting
HEDIS data reporting primarily uses Administrative Data, Hybrid Data, Survey Data, and now Electronic Clinical Data Systems (ECDS). ECDS is a growing trend in HEDIS reporting that allows for a more comprehensive view of patient care. This method uses direct data extraction from several sources such as, administrative claims, clinical registries, health information exchanges, immunization information systems, disease/case management systems and electronic health records. Measures that have transitioned to ECDS are indicated by an ‘E’ behind the measure acronym.
| Method | Data Source |
|---|---|
| Administrative | Enrollment, Claims, Encounters |
| Hybrid (Administrative + Sample) | Manual Medical Record Review |
| Survey | CAHPS, Medicare Health Outcomes Survey |
| ECDS | Enrollment, Claims, Encounters, EHRs, Registries, Case Management |
To learn more about ECDS reporting, click here.