HEDIS 2020 Volume 2 (hard copy)

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HEDIS 2020 Volume 2: Technical Specifications for Health Plans

A required resource for anyone involved in collecting, calculating or submitting HEDIS data, HEDIS Volume 2 features the complete technical specifications for each measure. It also includes general guidelines for data collection and reporting, detailed instructions about how to perform the necessary calculations and guidelines for sampling.

NCQA anticipates release of this hard copy publication in mid-July. All preorders of this product will ship shortly thereafter.

HEDIS is the gold standard in health care performance measurement, used by more than 90 percent of the nation's health plans and many leading employers and regulators. HEDIS is a set of standardized measures that specifies how organizations collect, audit and report performance information across the most pressing clinical areas, as well as important dimensions of customer satisfaction and patient experience.

Note: ECDS (Electronic Clinical Data Systems) measures in digital format are not included with the HEDIS 2020 Volume 2 publication. HEDIS 2020 ECDS measures are only available by purchasing one of the following products:

HEDIS 2020 Volume 2 will incorporate the following additional content, providing added value to our customers:

Rules for Allowable Adjustments of HEDIS: Recognizing that HEDIS measures have traditionally been specified for health plan reporting, and that the industry desires to apply the measures to different levels of the health care system to facilitate, for example, population health management and development of quality improvement programs and initiatives, NCQA incorporated the “Rules for Allowable Adjustments of HEDIS,” (the “Rules”) into HEDIS Volume 2 alongside applicable HEDIS measures and specifications. The Rules describe an approach and prescribe guidelines for adjusting NCQA’s HEDIS measure specifications for use with other populations. The Rules were reviewed and approved by NCQA measure experts and provide room for evaluating alternate populations without changing the clinical intent of the measure through removal of continuous enrollment or product-line criteria, for example.

HEDIS 2020 Value Set Directory (VSD): The HEDIS VSD crosswalks HEDIS measure and specifications to third party medical and billing codes to assist in calculating HEDIS measure results, The HEDIS VSD consists of a locked Excel file (.xlsx) that is made available with the purchase of HEDIS 2020 Volume 2 in print or electronic format. The HEDIS VSD is searchable and sortable. The HEDIS VSD is available in electronic format only; customers who purchase the print version of HEDIS Volume 2 will receive the measures in print and the HEDIS VSD in electronic form. These third-party codes may be protected under federal copyright laws and are included in HEDIS Volume 2 with the permission of the copyright owners. All uses of these third-party codes may require a license from the copyright owner. The HEDIS VSD now includes SNOMED and RxNorm codes that help health care organizations take greater advantage of the Rules. These additional codes may not be used to assist in calculating HEDIS measure results for health plan reporting to NCQA.

Note: The October updates—as listed in the Technical Specifications Update document on the NCQA website—are not automatically incorporated into the standard HEDIS Volume 2 publication. A HEDIS Volume 2 epub with October updates incorporated is made available only to members of the HEDIS User Group (HUG) as a membership incentive, and may be obtained by purchasing a HUG membership publication package. You can find more information about HUG membership here and purchase it through the NCQA Store here.

    

 
IMPORTANT: Permitted Use Notice

The HEDIS measures and specifications contained in HEDIS Volume 2 publication were developed by and are owned by NCQA. Unauthorized internal distribution of the publication and materials therein—beyond the number of users licensed by your organization—is prohibited. Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional licensed user permissions via the NCQA Store.

An organization’s licensed users may use the materials solely for an internal non-commercial purpose without obtaining NCQA approval. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications and/or HEDIS VSD into any product or service to calculate measure results for customers for any purpose) and/or any external reproduction, distribution or publication (including but not limited to federal and state entities using or incorporating the measures into their programs) must be approved by NCQA and are subject to a license at the discretion of NCQA.

Anyone contemplating a commercial use, external reproduction, distribution or publication of any part of HEDIS Volume 2, should not purchase HEDIS Volume 2 via the NCQA Store, but must contact the NCQA licensing team by submitting a request through https://my.ncqa.org to discuss the need for a custom license.

NOTE: Healthcare organizations that calculate HEDIS measure results using internal software (e.g., not a vendor) may publish their measure rates. However, the following disclaimer language must be used, as applicable:

Unadjusted Uncertified Measures: The logic used to produce these HEDIS® measure results has not been certified by NCQA. Such results are for reference only and are not an indication of measure validity. A calculated measure result (a “rate”) from a HEDIS measure that has not been certified via NCQA’s Measure Certification Program, and is based on unadjusted HEDIS specifications, may not be called a “Health Plan HEDIS rate” until it is audited and designated reportable by an NCQA-Certified HEDIS Compliance Auditor. Until such time, such measure rates shall be designated or referred to as “Uncertified, Unaudited Health Plan HEDIS Rates.”

Adjusted Uncertified Measures: The logic used to produce these HEDIS® measure results has not been certified by NCQA. Such results are for reference only and are not an indication of measure validity. A calculated measure result (a “rate”) from a HEDIS measure that has not been certified via NCQA’s Measure Certification Program, and is based on adjusted HEDIS specifications, may not be called an “Adjusted HEDIS rate” until it is audited and designated reportable by an NCQA-Certified HEDIS Compliance Auditor. Until such time, such measure rates shall be designated or referred to as “Uncertified, Adjusted, Unaudited HEDIS Rates.”

  

 

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