Payers required to submit HEDIS data to the Office submit measures calculated using either administrative or medical chart data, or sometimes both. Here’s how the measures break down:

Administrative Data Only

These measures are calculated using only administrative (claims) data, similar to what we are collecting in the All Payer Claims Database.

  • Adherence to Antipsychotic Medications for Individuals With Schizophrenia
  • Adults' Access to Preventive/Ambulatory Health Services
  • Annual Dental Visit
  • Annual Monitoring for Patients on Persistent Medications
  • Antidepressant Medication Management
  • Appropriate Testing for Children with Pharyngitis
  • Appropriate Treatment for Children With URI
  • Asthma Medication Ratio
  • Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
  • Breast Cancer Screening
  • Call Answer Timeliness
  • Children and Adolescents' Access to Primary Care Practitioners
  • Chlamydia Screening in Women
  • Diabetes Monitoring for People With Diabetes and Schizophrenia
  • Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication
  • Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
  • Follow-Up After Hospitalization for Mental Illness
  • Follow-Up Care for Children Prescribed ADHD Medication
  • Initiation and Engagement of AOD Dependence Treatment
  • Medication Management for People With Asthma
  • Metabolic Monitoring for Children and Adolescents on Antipsychotics
  • Non-Recommended Cervical Cancer Screening in Adolescent Females
  • Persistence of Beta-Blocker Treatment After a Heart Attack
  • Pharmacotherapy Management of COPD Exacerbation
  • Use of Appropriate Medications for People With Asthma
  • Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
  • Use of Imaging Studies for Low Back Pain
  • Use of Multiple Concurrent Antipsychotics in Children and Adolescents
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD

Either Administrative Data Only OR Administrative & Medical Chart Data

Some payers are calculating these measures using only administrative data while others choose to use a combination of administrative data and chart reviews. The results in inconsistencies based on their preference. All of these measures can be calculated with only administrative data.

  • Adolescent Well-Care Visits
  • Adult BMI Assessment
  • Cervical Cancer Screening
  • Childhood Immunization Status
  • Colorectal Cancer Screening
  • Comprehensive Diabetes Care
  • Controlling High Blood Pressure
  • Human Papillomavirus Vaccine for Female Adolescents
  • Immunizations for Adolescents
  • Lead Screening in Children
  • Prenatal and Postpartum Care
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
  • Well-Child Visits in the First 15 Months of Life
  • Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life

Administrative &Medical Chart Data

None of the payers calculate this measure using only administrative data.

  • Frequency of Ongoing Prenatal Care