HEDIS MY 2024 underway, submit CBI data + IHA reporting updates
Medical records request for HEDIS Measurement Year (MY) 2024
The annual Healthcare Effectiveness Data and Information Set (HEDIS) project is underway! California’s Department of Health Care Services (DHCS) requires health plans to collect and report HEDIS data annually.
Please be on the lookout for a patient medical record request from our vendor, KDJ Associates, Inc., between February and May 2025. They may contact you via:
- Fax.
- Mail.
- On-site visits.
- Remote electronic medical record (EMR) system access.
Please submit requested documentation within five days.
HEDIS measures under review
The following HEDIS measures will be reviewed this year:
- Childhood Immunization Status.
- Immunizations for Adolescents.
- Cervical Cancer Screening.
- Prenatal and Postpartum Care.
- Controlling High Blood Pressure.
- Lead Screening in Children.
- Glycemic Status Assessment for Patients with Diabetes.
How we use this data
We use this data to develop and enhance educational programs and member/provider benefits and to monitor:
- Quality of care delivered.
- Rate at which members access preventive services.
- Indicators of how well members are managing chronic conditions.
- Provider performance.
- Health plan performance.
Questions
Find answers to frequently asked questions in the HEDIS FAQ Guide.
You can also contact CJ Vansant, Alliance Quality Improvement Project Specialist, at either (831) 430-5553 or [email protected].
Thank you for your cooperation and participation in this important project.
Submit 2024 CBI data by Feb. 28
The deadline to submit your Care-Based Incentive (CBI) 2024 data is Feb. 28, 2025. The Data Submission Tool (DST) is available on the Alliance’s Provider Portal under “Data Submissions.” This tool supports providers in submitting data from their electronic medical records and paper records for the CBI and Healthcare Effectiveness Data and Information Set (HEDIS) measures.
Measures you can submit data for include:
- Breast Cancer Screening (screening and mastectomies).
- Cervical Cancer Screening (Pap and HPV screenings and hysterectomies).
- Child and Adolescent Well-Care Visits (0-21 years).
- Chlamydia Screening in Women.
- Colorectal Cancer Screening.
- Controlling High Blood Pressure (systolic and diastolic readings).
- Developmental Screening in the First 3 Years.
- Diabetic HbA1c Poor Control >9.0%.
- Fluoride Varnish.
- Immunizations for Children, Adolescents and Adults.
- Initial Health Appointment (IHA).
- Screening for Depression and Follow-Up Plan.
After you submit your data, you will receive an email confirmation within one business day.
Tips for successful submission
- If your file was previously rejected, please review the reason for rejection, correct it and resubmit. If you have any questions about why the file was rejected, please contact your Provider Relations Representative at 800-700-3874. ext. 5504.
- A Data Submission Tool Guide is available on the Portal. This guide provides step-by-step instructions on the information required for each measure, how to upload and how to correct rejections.
If you have questions about the Data Submission Tool, please email [email protected].
Initial Health Appointment reporting update
To improve Initial Health Appointment (IHA) reporting, IHA “dummy code” (99499) submissions must now be submitted via the Data Submission Tool (DST).
The Provider Portal now includes the dummy code submission that providers can use after three unsuccessful outreach attempts to members. The report will now display both submitted IHA claims and dummy code via the Data Submission Tool (DST).
IHA dummy codes submitted from claims will no longer be accepted, effective as of Jan. 1, 2025.
This change was implemented to streamline your workflow and reduce duplicate efforts.
If you have any questions, please email [email protected].