Provider Reference Library: HEDIS Guides

General References for HEDIS Compliance 

• Scheduling Guidelines
• HEDIS FAQs
• How to Close Gaps
• Closing Gaps in Care
• No Show Strategies

Adult Medical Conditions and Preventive Care

• Asthma Medication Ratio (AMR)
• Breast Cancer Screening (BCS-E)
• Care for Older Adults (COA)
• Cervical Cancer Screening (CCS)
• Child and Adolescent Well-Care Visits (WCV)
• Childhood Immunization Status (CIS)
• Chlamydia Screening in Women (CHL)
• Colorectal Cancer Screening (COL-E)
• Controlling High Blood Pressure (CBP)
• Immunizations for Adolescents (IMA)
• Follow-Up After ED Visit for People with Multiple High Risk Conditions (FMC)
• Plan All-Cause Readmissions (PCR)
• Prenatal and Postpartum Care (PPC)
• Osteoporosis Management in Women who had a Fracture (OMW)
• Social Need Screening and Intervention (SNS-E)
• Statin Therapy for Patients with Cardiovascular Disease (SPC)
• Transitions of Care (TRC)
• Well-Child Visits in the First 30 Months of Life (W30)

Behavioral Health Care 

• Adherence Antipsychotic Medications Individuals Schizophrenia (SAA)
• Antidepressant Medication Management (AMM)
• Diabetes Screening for People with Schizophrenia or Bipolar Disorder on Antipsychotics (SSD)
• Follow-Up After Emergency Department Visit for Mental Illness (FUM)
• Follow-Up After Emergency Department Visit for Substance Use (FUA)
• Follow-Up After Hospitalization for Mental Illness (FUH)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Initiation and Engagement of Substance Use Disorder Treatment (IET)
• Initiation for Pharmacotherapy Upon New Episode of Opioid Dependence (POD-N) (QARR Measure)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
• Use of Opioids at High Dosage (HDO)
• Use of Pharmacotherapy for Alcohol Use or Dependence (POA) (QARR Measure)

Child and Adolescent Care 

• Child and Adolescent Well-Care Visits (WCV)
• Childhood Immunization Status (CIS)
• Follow-Up Care for Children Prescribed ADHD Medication for Attention Deficit Disorder (ADD)
• Immunizations for Adolescents (IMA) 
• Metabolic Monitoring for Child and Adolescents on Antipsychotics (APM)
• Asthma Medication Ratio (AMR)
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC)
• Well-Child Visits in the First 30 Months of Life (W30)

Diabetes Care 

• Blood Pressure Control for Patients with Diabetes (BPD)
• Eye Exam for Patients with Diabetes (EED)
• Glycemic Status Assessment for Patients with Diabetes (GSD)
• Kidney Health Evaluation for Patients with Diabetes (KED)
• Statin Therapy for Patients with Diabetes (SPD)

HEDIS Measures and Gaps in Care Resources 

• Closing Gaps in Care in 2023 (PDF) 
• Gaps in Care Timeline (PDF) 
• Medical Records Submission Guidelines (PDF) 
• Gaps in Care Documentation Guidelines (PDF)
• Accessing Gaps in Care Reports Step-by-Step Guide (PDF)
• MVP Provider Online Account Registration Instructions (PDF)
• Primary Care Provider Change or Patient Reassignment Request (PDF)
• Medical Record Transmission Cover Sheet (PDF)
• Transitions of Care (TRC)
• Transitions of Care (TRC) Compliance Overview

Gaps in Care Webinar

The gaps in care submission process outlines how Providers should submit medical record documentation to MVP to close gaps in care identified in MVP reporting. Please review this presentation from the MVP HEDIS Operations Team.