• Skip to main content
Skip to content
  • Find a Doctor
  • Nurse Line
  • Provider Portal
  • Contact Us
  • aA Accessibility Tools

    GrayscaleAAA

  • English
  • Spanish
English
English Spanish Hmong Panjabi Vietnamese Arabic Chinese Portuguese Russian Tagalog Korean Persian
AllianceWhiteLogo
  • For Members
    • Get Started
      • Member ID Card
      • Find a Doctor
        • Alliance Alternative Access Standards
      • About Your Health Plan
      • Frequently Asked Questions
    • Get Care
      • Primary Care
        • Approvals for Care
      • Nurse Advice Line
      • Prescriptions
        • Medi-Cal Prescriptions
        • Alliance Care IHSS Prescriptions
        • Medications and Your Health
      • Urgent Care
        • Urgent Visit Access – Mariposa County
        • Urgent Visit Access – Merced County
        • Urgent Visit Access – Monterey County
        • Urgent Visit Access – San Benito County
        • Urgent Visit Access – Santa Cruz County
        • What to do after the emergency room: Your action plan
      • Care Management for Members
      • Behavioral Health
      • Transportation Services
      • Enhanced Care Management and Community Supports
      • Other Services
        • Dental and Vision
        • Family Planning
        • Medical Equipment
        • Out-of-Area Services
    • Member Services
      • Access Your Health Information
      • COVID-19 Information
        • General COVID-19 Information
        • COVID-19 Testing and Treatment
        • COVID-19 Vaccine Information
      • Language Assistance
      • File a Grievance
      • California Children’s Services
      • Join an Advisory Group
        • Member Services Advisory Group (MSAG)
          • Member Services Advisory Group Application
        • Whole Child Model Family Advisory Committee (WCMFAC)
      • Member News
      • Prepare for an Emergency
    • Online Self-Service
      • Replace ID Card
      • Choose Primary Doctor
      • Insurance Information
      • Update Contact Information
        • Information Release
        • Privacy Request
        • Request Personal Representative
      • Confidential Communications Request Form
      • Find a Form
    • Health and Wellness
      • Health Rewards Program
      • Wellness Resources
  • For Providers
    • Join Our Network
      • Why Join
      • How to Join
      • Provider Network Interest Form
      • Become a D-SNP Provider
    • Manage Care
      • Behavioral Health
      • California Children’s Services
      • Clinical Resources
        • Care Management
          • Complex Case Management and Care Coordination
          • Pain Management and Substance Use Resources
          • Seniors and Disabilities
        • Nurse Advice Line
        • Referrals and Authorizations
        • Telehealth Services
      • Cultural and Linguistic Services
        • Interpreter Request Form
        • Smart Interpreter Request Form
        • Interpreter Services Provider Quick Reference Guide
        • Interpreter Services Quality Assurance Form
        • A to Z Glossary of Spanish & Hmong Terms
      • Enhanced Care Management and Community Supports
        • Enhanced Care Management (ECM)
        • Community Supports (CS)
        • ECM/CS Referrals
        • ECM/CS Trainings
        • ECM/CS FAQs
      • Health Education and Disease Management
        • Health Education Programs
        • Disease Management Programs
        • Health Resources
      • Pharmacy
        • Medi-Cal Pharmacy
        • Alliance Care IHSS Pharmacy
        • Physician-Administered Drugs (for Medi-Cal and IHSS)
        • Drug Recalls and Withdrawals
        • Additional Pharmacy Information
      • Quality of Care
        • Provider Incentives
          • Care-Based Incentive
            • Care-Based Incentive Resources
              • Care-Based Incentive (CBI) Summary
              • CBI Technical Specifications
              • Antidepressant Medication Management Tip Sheet
              • Immunizations: Adult – Exploratory Measure Tip Sheet
              • Immunizations: Adolescents Tip Sheet
              • Programmatic Measure Benchmarks
              • Asthma Medication Ratio Tip Sheet
              • 90-Day Referral Completion – Exploratory Tip Sheet
              • Antidepressant Medication Management Tip Sheet
              • Application of Dental Fluoride Varnish Tip Sheet
              • Immunizations: Children (Combo 10) Tip Sheet
              • Chlamydia Screening in Women Tip Sheet
              • Child and Adolescent Well-Care Visits Tip Sheet
              • Cervical Cancer Screening Tip Sheet
              • Child and Adolescents BMI Assessment Tip Sheet
              • Breast Cancer Screening Tip Sheet
              • Well-Child Visits in the First 15 Months of Life Tip Sheet
              • Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
              • Preventable Emergency Visits Tip Sheet
              • Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet
              • Maternity Care: Prenatal Tip Sheet
              • Maternity Care: Postpartum Tip Sheet
              • Plan All-Cause Readmissions Tip Sheet
              • Lead Screening in Children Tip Sheet
              • Initial Health Appointment Tip Sheet
              • Diabetic HbA1c Poor Control >9% Tip Sheet
              • Developmental Screening in the First 3 Years Tip Sheet
              • Controlling High Blood Pressure – Exploratory Measure Tip Sheet
              • Immunizations: Children (Combo 10) Tip Sheet
              • Best Practices for Reducing Patient No-Shows Tip Sheet
              • Ambulatory Care Sensitive Admissions Tip Sheet
              • Depression Tool Kit
              • USPSTF Recommendations for Primary Care Practice
              • Preventable Emergency Visits Diagnoses Tip Sheet
              • Blood Lead Testing Flyer
              • Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet
              • Depression Screening for Adolescents and Adults Tip Sheet
          • Data Sharing Incentive
          • Specialty Care Incentive Measures
          • Skilled Nursing Facility Workforce and Quality Incentive Program (WQIP)
            • Skilled Nursing Facility Workforce and Quality Incentive Program Provider FAQs
        • Health Assessments
        • HEDIS
          • HEDIS Resources
            • HEDIS Code Set
            • HEDIS FAQ Guide
        • Immunization Resources
        • Member Incentives
        • CAHPS – Member Experience
        • Site Reviews
          • Facility Site Review
            • Infection Control: Spore Testing Job Aid
            • DHCS Facility Site Review (FSR) Checklist
            • FSR Critical Elements: Interim Monitoring Form
          • Medical Record Review
            • DHCS Medical Record Review (MRR) Checklist
          • Physical Accessibility Review Survey
    • Resources
      • COVID-19
      • Claims
        • View/Submit a Claim
      • Forms
        • Provider Directory Update Form
      • Provider Credentialing Applications and Policies
        • Re-Credentialing
      • News
      • Provider Directory
      • Provider Manual
        • All Plan Letters
      • Timely Access to Care
      • Webinars and Training
        • Provider Events Calendar
      • Emergency Preparedness
    • Provider Portal
      • Using the Provider Portal
        • Frequently Asked Questions
        • Provider Portal User Guide
        • Provider Portal Quick Reference
        • Provider Portal Account Request Form
        • Procedure Code Lookup Tool (PCL)
    • Check out the latest All Plan LettersGet updates from DHCS.
  • For Communities
    • Healthy Communities
      • Your Health Matters
      • Community Events
      • Community-Based Adult Services
      • Community Health Worker Benefit
      • Community Resources
      • Doula Services Benefit
      • Enhanced Care Management and Community Supports
    • Funding Opportunities
      • Medi-Cal Capacity Grants
        • Access to Care
          • Capital Program
          • Data Sharing Support Program
          • Equity Learning for Health Professionals Program
          • Healthcare Technology Program
          • Workforce Recruitment Programs
            • CHW Recruitment Program
            • Doula Recruitment Program
            • MA Recruitment Program
            • Provider Recruitment Program
        • Healthy Beginnings
          • Home Visiting Program
          • Parent Education and Support Program
        • Healthy Communities
          • Community Health Champions
          • Partners for Active Living Program
        • How to Apply
        • Grants at Work
      • Alliance Housing Fund
      • Other Funding Opportunities
    • Community Publications
      • Community Impact Reports
      • The Beat E-Newsletter
    • Come see us at a community event!Stop by to learn about Medi-Cal and Alliance services.
  • Health Plans
    • Medi-Cal
    • Alliance Care IHSS
      • Alliance Care IHSS Price Transparency Tool
    • See if you qualify for Medi-CalContact your county human services office or apply online anytime at BenefitsCal.com.
  • About Us
    • About the Alliance
      • Fact Sheet
        • Medi-Cal Fast Facts
      • Mission, Vision and Values
      • Strategic Plan 2022-2026
      • Leadership
      • Public Meetings
      • Regulatory Information
      • Careers
      • Contact Us
    • News
      • Community News
      • Member News
      • Provider News
      • Meetings and Events
      • Newsroom
    •  
    • See our latest Medi-Cal Fast FactsLearn who we serve and how we support our members.
Web-Site-InteriorPage-ForProviders
Home > For Providers > Manage Care > Quality of Care > HEDIS > HEDIS Resources > HEDIS FAQ Guide

Manage Care

HEDIS FAQ Guide

Health Care Effectiveness Data and Information Set (HEDIS).

What is HEDIS?

Healthcare Effectiveness Data and Information Set (HEDIS) is a performance measurement tool developed and
administered by the National Committee for Quality Assurance (NCQA) and used by the California Department of
Health Care Services (DHCS) to monitor the performance of Medi-Cal managed care plans.

  • The Alliance performs an annual compliance audit that conforms with a subset of HEDIS measures, referred to as the Managed Care Accountability Sets (MCAS). The MCAS includes performance measures developed by the Centers for Medicare & Medicaid Services (CMS) and NCQA
  • All Medi-Cal plans undergo annual, retrospective HEDIS reviews to monitor specific domains of care.
  • Results are used to measure performance, identify quality initiatives, and provide educational programs for providers and members.
What is a provider's role in HEDIS reporting?

Providers play a central role in promoting the health of Alliance members. Providers and office staff can help support the HEDIS process by:

  • Providing appropriate care within designated time frames.
  • Documenting all care in the patient’s medical record.
  • Accurately coding all claims and billing the Alliance in a timely manner.
Do I need member consent to release personal health information (PHI) for HEDIS reporting?

No. Under the Health Information Portability and Accountability Act (HIPAA), data collection for HEDIS is permitted
and health plan requests for medical records do not require additional patient consent or authorization. Alliance members’ PHI is maintained in accordance with all state and federal laws.

What data sources are used in HEDIS reporting?
  • Administrative data obtained from the Alliance’s claims system.
  • Laboratory data.
  • Data submitted via the Alliance’s Data Submission Tool on the Provider Portal.
  • Immunization Registry data.
  • Chart data obtained from medical record review.
How will the Alliance collect HEDIS data?

The Alliance’s HEDIS medical record collection and abstraction vendor, KDJ, will contact providers directly to request medical records for select members.

  • Data collection methods include fax, mail, on-site visits, and remote electronic medical record (EMR)
    system access.
  • Providers should submit requested documentation within five days of medical record request.
When does medical record review begin and end?

Medical record requests will begin as early as February and end by mid-May.

Should the entire medical record be sent?

No. Each request will include a list of members, the measure(s) selected for review and the relevant portions of medical records that are needed.

Who is the contact for questions about HEDIS medical record requests?

When the record requests are sent, contact instructions will be listed on the request.

Does HEDIS MY 2024 apply to just records and claims in 2024?

No. HEDIS measurement year (MY) 2024 can look back as many as ten years for some measures.

Where can I get more information about NCQA and HEDIS?

More information can be found at www.ncqa.org.

Will I be reimbursed for copies/materials?

Per your Alliance contract, we do not reimburse for medical record copies/materials requested for HEDIS data collection.

Is there a direct line for general questions related to HEDIS?

Please direct any HEDIS questions to [email protected].

Contact Quality Improvement

  • [email protected]

Contact Provider Services

Provider Relations Representative 800-700-3874,
ext. 5504
Practice Coaching
[email protected]
CBI Team
[email protected]

Provider Resources

  • Provider Portal
  • Provider Manual
  • Training Page
  • Health Education and Disease Management
  • Behavioral Health
  • Immunization Resources

Latest CBI News

Attend these upcoming Adverse Childhood Experiences (ACEs) trainings

Attend these upcoming Adverse Childhood Experiences (ACEs) trainings

November 5, 2024
Provider Digest | Issue 50

Provider Digest | Issue 50

June 25, 2024
Provider Digest | Issue 43

Provider Digest | Issue 43

March 4, 2024
Provider Digest | Issue 41

Provider Digest | Issue 41

February 6, 2024
Provider Digest | Issue 36

Provider Digest | Issue 36

October 30, 2023

Contact us | Toll free: 800-700-3874

Button - Go To Page Top
Central California Alliance for Health Logo

Get Help

Nurse Advice Line
Language Assistance
Frequently Asked Questions

Member Resources

GRIEVANCE FORM
Member Handbook
Health Rewards Program
Continuity of Care Policy

The Alliance

Careers
Contact Us
Compliance Concerns

Accessibility Tools

AAA

Healthy people. Healthy communities.
  • Glossary of Terms
  • Privacy Policy
  • Terms and Conditions
  • Nondiscrimination Notice
  • Notice of Privacy Practices
  • Regulatory Information
  • Site Map
Connect on LinkedIn
Connect on Facebook

© 2025 Central California Alliance for Health | Website Feedback