Policies & Guidelines
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- Legal References
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- Ambulatory Surgical Services
- Billing Policy
- CFSS
- Children's Services
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- Clinic Services
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- Inpatient Hospital Notification and Authorization
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- Long-Term Care
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- Quality: HEDIS
- Policies & Procedures
Quality: Healthcare Effectiveness Data and Information Set (HEDIS®)1
Cooperation with HEDIS Chart Abstractions
HEDIS is an annual performance measurement created by NCQA and used to help establish accountability and improve the quality of health care. PrimeWest Health is required by our contracts with the CMS and DHS to report HEDIS measurements. Medical record data abstraction is used to improve the measurement rates by supplementing administrative data mined through claims. PrimeWest Health requires all providers to help complete this process in the most efficient manner possible. Participating in quality management activities is specified in your provider contract with PrimeWest Health; you do not need to get special patient permission for the chart data abstraction process.
PrimeWest Health staff reach out to providers annually to ensure we have updated contact information, to confirm the method by which records will be received, and to test any technology processes prior to the start of the year’s HEDIS activities. In order to reduce provider burden, PrimeWest Health begins annual HEDIS activities as early as possible, and may begin requesting HEDIS-related records from you starting in the fall.
PrimeWest Health requires all providers to cooperate with HEDIS chart abstraction. We expect that PrimeWest Health will be given full access to medical charts and will be allowed retrieve appropriate supporting documentation. Without this supporting documentation, it is impossible to follow the NCQA HEDIS Compliance standards that are required of PrimeWest Health.
For more information, or if you have questions about HEDIS, please contact a member of PrimeWest Health’s HEDIS team at HEDIS@primewest.org, 1-32-759-4155 (phone), or 1-320-335-5331 (fax).
1HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)
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Updated_10/13/2022
