Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid Supplemental Data Sets (SDS)

February 1, 2022

BCBSTX Medicaid is requesting that providers send their quality measure data to us via a standard monthly automated Electronic Health Record (EHR), or SDS feed. Submitting your quality measures via a standardized process to BCBSTX allows for better reporting and meeting of your Healthcare Effectiveness Data and Information Set (HEDIS®) and other clinical quality measure rates.

The standard file layout is auditor approved and all valid submissions will count towards your HEDIS measure rates. It can reduce the burden of your billing staff when submitting Current Procedural Terminology (CPT II) informational codes with claims, or your office staff, during the HEDIS® Hybrid data collection season each year.

The SDS or EHR data feeds bring in the Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD), Logical Observation Identifiers Names and Codes (LOINC), Systemized Nomenclature of Medicine (SNOMED), Vaccine Administered (CVX), and Current Procedural Terminology (CPT) codes, so the Plan can monitor member gaps in care on a more real-time basis.

The standard measure set includes well visit and prevention measures such as:

  • Controlling Blood Pressure (CBP)
  • Child and Adolescent Well-Care Visits (WCV)
  • Weight Assessment and Counseling (WCC)
  • Immunizations for Adolescents (IMA)
  • Cervical Cancer Screening (CCS)
  • Breast Cancer Screening (BCS)

Along with other hard to obtain diabetes measures such as the following:

  • Hemoglobin A1c Control for Patients with Diabetes (HBD)
  • Blood Pressure Control for Patients with Diabetes (BPD)
  • Eye Exam for Patients with Diabetes (EED)

Initial roll-out is on average, six weeks to two months and involves technical and clinical validation. Once the automated monthly file feeds are established, you may incorporate all BCBSTX Lines of Business including Medicare, or Retail/Commercial, improving rates for all BCBSTX benefit plans you may have.

If interested in learning more, please submit an email and add cc:

Reference and review the BCBSTX Preventive Care Guidelines (PCGs)Clinical Practice Guidelines (CPGs), and THSteps for Medical Providers which includes all current vaccine schedules, ImmTrac2 , and other important guidance for treating your patients.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations, and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.