We collect quality data from providers to measure and improve the care our members receive. Our tip sheets can help you satisfy quality measures. These include Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance and National Quality Forum measures.
Complying with these measures may reduce the need for you to provide medical records later for review.
The tip sheets below are for Measurement Year 2023.
Note: The tip sheets below do not have diagnosis and procedure codes. Providers can access tip sheets which include common diagnosis and procedure codes on Availity ® Essentials:
- Sign into Availity® Essentials
- Navigate to Payer Spaces
- On the Resources tab select Quality Improvement Tip Sheets to open and locate the Tip Sheet
Medical Tip Sheets
- Adults' Access to Preventive/Ambulatory Health Services
- Appropriate Testing for Pharyngitis
- Appropriate Treatment for Upper Respiratory Infection
- Avoidance of Antibiotic Treatment for Acute Bronchitis
- Breast Cancer Screening
- Cervical Cancer Screening
- Child and Adolescent Well-Care Visits
- Childhood Immunization Status
- Children and Adolescents’ Access to Primary Care Practitioners HEDIS® Tip Sheet
- Chlamydia Screening in Women
- Colorectal Cancer Screening
- Comprehensive Diabetes Care
- Comprehensive Diabetes Care – HbA1c Test
- Comprehensive Diabetes Care – Retinal Eye Exam
- Comprehensive Diabetes Care – Nephropathy
- Controlling High Blood Pressure
- Follow-Up After Emergency Department Visit for People with High-Risk Multiple Chronic Conditions
- Hemoglobin A1c Control for Patients With Diabetes
- Immunizations For Adolescents
- Kidney Health Evaluation for Patients with Diabetes
- Lead Screening in Children
- Non-Recommended Cervical Cancer Screening in Adolescent Females
- Osteoporosis Management in Women Who Had a Fracture
- Pharmacotherapy Management of COPD Exacerbation
- Plan All-Cause Readmissions
- Potentially Harmful Drug-Disease Interactions in the Elderly
- Prenatal and Postpartum Care
- Prenatal and Postpartum Depression Screening and Follow-Up (PND and PDS)
- Primary Open-Angle Glaucoma
- Statin Therapy for Patients with Cardiovascular Disease
- Use of Imaging Studies for Low Back Pain
- Use of Spirometry Testing in the Assessment and Diagnosis of COPD
- Well-Child Visits in the First 30 months of Life
Behavioral Health HEDIS Tip Sheets
- Antidepressant Medication Management (AMM)
- Diabetes Screening for Members Taking Antipsychotics (SSD)
- Follow-Up After Emergency Department for Substance Use (FUA)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)
- Follow-Up after Hospitalization for Mental Illness (FUH)
- Follow-Up Care for Children Prescribed ADHD Medication (ADD)
- Initiation and Engagement of Substance Use Disorder Treatment (IET)
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
- Pharmacotherapy for Opioid Use Disorder (POD)
- Use of Opioids from Multiple Providers (UOP)
HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here. The NCQA HEDIS measure specification has been adjusted pursuant to NCQA’s Rules for Allowable Adjustments of HEDIS. The adjusted measure specification may be used only for quality improvement purposes.
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.