Chlamydia Screening in Women Tip Sheet

Incentives are paid to the linked primary care provider (PCP) on an annual basis, following the end of quarter four. For additional information, refer to the CBI Technical Specifications.

Members who are 16 to 24 years of age at the end of the measurement year and identified as sexually active. Sexual activity is determined by any of the following:

• Pregnancy test or diagnosis.
• Claim/encounter noting sexual activity.
• Contraceptive medication (see CBI Technical Specifications for a full list of medications).

Note: Laboratory claims with POS 81 are not included to identify eligible members through claims with a sexual activity diagnosis.

• Administrative members at the end of the measurement period.
• Dual coverage members.
• Members in hospice, receiving hospice services, or who died during the measurement year.
• Members identified as eligible for the measure based on a pregnancy test alone are removed from the measure for any of the following:
  • A pregnancy test during the measurement year and an X-ray on the date of the pregnancy test or six days after the pregnancy test.
  • A pregnancy test during the measurement year and a prescription for isotretinoin (retinoid) on the date of the pregnancy test or six days after the pregnancy test.

Chlamydia Screening CPT Codes:

• 87110, 87270, 87320, 87490, 87491, 87492, 87810

View the full list of chlamydia screening and exclusion codes in the CBI Technical Specifications.

Data for this measure is collected using claims, laboratory data, pharmacy data, and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

• Run a report from your electronic health record (EHR) system; or
• Manually compile patient data. For example, download your monthly Chlamydia and Gonorrhea Screening report or Care-Based Incentives Measure Details report from the Provider Portal and compare it to your EHR/paper records.

This measure allows providers to submit chlamydia test results from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. To submit, upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.

• Screen members 16-24 years of age annually, as well as older adults who are at an increased risk for infection.
• Screen patients who are prescribed birth control. Review the Chlamydia and Gonorrhea Screening report on the Provider Portal to determine members who are identified as sexually active.
• Consider using the opt-out approach to screening. Additional information shared in the American Academy of Pediatrics 2022 publication, Testing for Sexually Transmitted Infections: Providers Cannot Opt Out of the Conversation.
• Discuss sexual activity and remind members of safe sex practices. Screen if member mentions a new sexual partner or other risk factors.
• Follow the United States Preventive Services Task Force (USPSTF) recommendation for chlamydia and gonorrhea screening:
  • Screening adolescents and young adults <25 years of age: Annual chlamydia and gonorrhea screenings should be performed for women <25 years of age and older women at risk. Syphilis, HIV, chlamydia, and hepatitis B screenings should be given to all pregnant women. Gonorrhea screenings should be given to pregnant women at risk.
  • HIV screening: Should be performed for everyone 15-65 years of age. Younger adolescents and older adults who are at an increased risk of infection should also be screened.
• Develop and follow a written policy and protocol for staff and physicians.
• Establish routine clinic processes for chlamydia screenings and ensure time alone with adolescents, and time to confidentially collect specimens if they’re accompanied by parents. For follow-up results, it is recommended to collect a confidential number to call the adolescent back.
• Establish a patient recall system using the Chlamydia and Gonorrhea Screening report on the Provider Portal to get them scheduled for a test:
  • Members missing screenings: Let them know they need to return to the office to provide a urine sample. At that time, discuss the importance of the screening.
  • Cross-reference your list to those that are due for their annual well-visit. Put in a standing order for a urine test for when they come in for their visit.
• Consider the community you serve and consult the local health department to identify groups that are at increased risk in your area.
• Order a chlamydia test when a pregnancy test is administered.

• Alliance Cultural and Linguistic Services are available to network providers.
  • Language Assistance Services – request materials at 800-700-3874, ext. 5504.
  • Telephonic Interpreter Services – available to assist in scheduling members.
  • Face-to-Face Interpreter Services – can be requested for the appointment with the member.
  • For information about the Cultural and Linguistic Services Program, call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
• Alliance Transportation Services for patients with transportation challenges.
  • Non-emergency medical transportation (NEMT), call 800-700-3874, ext. 5640 (TTY: Dial 711).
  • Non-medical transportation (NMT), call 800-700-3874, ext. 5577 (TTY: Dial 711).
• Opt-Out Chlamydia Screening Should Be Part of Routine Adolescent Health Care Services
  - Contemporary Pediatrics 2021 report.
• Chlamydia - Center for Young Women’s Health.
• Improving Chlamydia Screening Strategies from top performing health plans – NCQA.
• Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources – CDC.
• Sexually Transmitted Infections Treatment Guidelines, 2021 for up-to-date clinical guidelines – CDC.
• Screening for Chlamydia and Gonorrhea – USPSTF.