2016 hedis training manual

Integrated healthcare association valuebased payfor. Hedis certify online abstraction and chart chaser training. Partnering with molina to promote and measure quality this section includes an overview on the processes of the hedis, medicare star and health outcome survey programs, and how molina will collaborate with you to promote and measure quality health care services. We will make sure you understand the ins and outs of the hedis field and also support you in getting your foot in the door. Health plan of san joaquin presents its annual hedis training modesto march 24th who. Pcp hedis quick reference guide universal american. Documenting patient education given is not sufficient. What is hedis coding hedis coding services medical coding. Hedis made easy what you really need to know disclaimer. Hedis 2017 volume 3 value set directory user manual.

Next level has a training program that is geared centered toward the nurse wishing to pursue a career as a clinical auditor or the healthcare worker that just needs a refresher course. Cares policy change from fme to fme, and informafon and. January 21, 2016 7 introduction welcome to sunshine health advantage. Medicare managed care manual chapter 5 quality assessment. For participating kentucky anthem blue cross and blue shield providers looking for access to our claims, eligibility, and precertification tools. Through hedis, ncqa holds sunshine health accountable for the timeliness and quality of healthcare services acute, preventive, mental health, etc delivered to its diverse membership. Apply to senior consultant, analyst, senior quality engineer and more. Hedis is how health insurance companies get accredited. We created the hedis quick reference guide to help you increase your practices hedis rates.

Introduction to hedis 2016 presented by the quality improvement department at gold coast health plan ventura countys medical managed care plan serving ventura county since july 1, 2011. This code was retired and replaced with cpt code 81528 on jan. Thank you for participating in our network of participating physicians, hospitals and other healthcare professionals. Hedis quick reference guide updated to reflect ncqa hedis 2016 technical specifications mhs health wisconsin strives to provide quality healthcare to our membership as measured through hedis quality metrics. Ncqa hedis program requirements,applicable laws, and l. Updated to reflect ncqa hedis 2016 technical specifications. Ncqa provides uptodate opportunities to help you reach your quality improvement goals and advance your career. Your 2016 guide to key hedis measures keywords healthcare effectiveness data and information set hedis measures help keystone first monitor care and identify opportunities to improve access to preventive and recommended services. This selfpaced, online training is a stepping stone to a successful hedis career.

The spreadsheet lists the hedis 2017 code changes by value set and includes the elements in the table below. Hedis training manual 2014 data collection and abstraction. Had cervical highrisk human papillomavirus hrhpv testing performed in 2015, 2016, 2017. The course consists of online presentations, interactions with your classmates, assignments.

There is no time limit to complete the training but we urge you to finish within 6 months because we want you to get out there and succeed. Information contained in this guide is based on ncqa hedis technical specifications. We offer an online hedis training that will prepare you to be a hedis professional. The measure set also includes survey measures based on questions from the qualified health plan enrollee experience survey qhp enrollee survey. Fitdna 2014 2016 anyof the three scenarios pass for fobt 1. We have highly qualified instructors with years of hedis experience. That makes hedis one of health cares most widely used performance improvement tools.

The informafon provided is in this document is for 2017 hedis period and is current at the fme this document was created. Next level ti will offer hedis training that provides information, tools, and resources to meet quality goals toward obtaining successful hedis scores. Please refer to for hedis program measures and guidelines as well as relevant statutes. An important part of quality improvement is keeping up with the latest in health care and learning from best practices. Medicaid provider manual due to the size of this document approximately 16mb, you may experience a delay before it opens. Hedis nurses helps relieve the stress and pressure of hedis chart abstraction by providing the industrys top professionals andor state of the art technology. Healthcare effectiveness data and information set hedis reports.

November 2016 measurement year 2016 vbp4p manual modifications to the health plan hedis compliance audit enrollment in. Carenational supports initiatives by the american staffing association to help bridge the skill gap in todays workforce. Share this page with a friend or colleague by email. Hedis 2017 volume 3 value set directory user manual 3 ncqa 2016 summary of changes codes the summary of changes codes spreadsheet identifies codes added to or deleted from a concept. Providers, office managers, medical assistants, billers 12. Different learning formats and levels are available to suit your needs. Weight assessment and counseling for nutrition and physical activity for childrenadolescents. Guide to hedis measures is a reference guide designed to help your practice. Uniform data system uds resources bureau of primary. Hedis and accreditation standards changes 2018 duration. Kim has 30 years of healthcare experience including practice administration, hedis, pay for performance, project management including building strong hedis. Hedis is a set of standardized performance measures developed by the national committee for quality assurance ncqa which allows comparison across health plans.

Hedis measures performance in health care where improvements can make a meaningful difference in peoples lives. Health plan of san joaquin presents its annual hedis training march 17. The 2016 hedis measures for qrs contained in this document are. Technical specifications for health plans by the national committee for quality assurance ncqa. Health plan of san joaquin presents its annual hedis training modesto march 24th. Hedis is part of an integrated system to establish accountability in managed care. If you are using a dialup modem, we recommend you use the cd version of the manual. This provider manual is a reference guide for providers and their staff providing services to members who.

Fidelis provider manual 416 4 introduction welcome to fidelis securecares medicaremedicaid plan fidelis mmp. Whether youre brand new to hedis or if you have performed hedis for decades, asking the right questions is the first step to improving your score. Hedis 2016 technical specifications for physician measurement 3 2017 case management for longterm services and supports standards and guidelines or. We understand that hedis specifications can be complex, so we have designed this manual to clearly define molinas criteria for meeting hedis guidelines. Documentation with the most recent hba1c test performed during 2016. The healthcare effectiveness data and information set hedis is a set of performance data developed and maintained by the national committee for quality assurance ncqa, and is the most widely used standardized performance measure in the managed care industry. If you are trying to get a very flexible job, hedis. Hedis is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of health care plans as.

Youve asked for it and now carenational is going to provide it, hedis training and certification. The tables below explain the national committee for quality assurance ncqa healthcare effectiveness data and information set hedis measures for two types of care. However we may serve as a point of reference for your future employment or contract. How to improve your hedis rates increase your opportunity for provider incentives 12. Ongoing support for the first 6 months will be provided after completion of the training, assistance in talloring your resume will also be provided. Health educationanticipatory guidance related to medications or immunizations or. Epubs are protected microsoft word and excel files sent to the purchaser via email. Health plan of san joaquin presents its annual hedis. All other documents on this website are accessible using a. Thank you for participating in our network of physicians, hospitals and other healthcare professionals. This section includes measure specifications and data. Ncqa is a nonprofit organization dedicated to improving health care quality. Members discharged for cabg during 2016 or the year prior. Certification and training course 2019 hedis season.

We are offering an online hedis training that will prepare you to be a high performing hedis professional. This selfpaced, online training is a stepping stone to a successful hedis. Member attribution will be refreshed, linking the member to the pps using the january 2016 file reflecting attribution results for july 2014 to june 2015 claims and encounters. Healthcare effectiveness data and information set hedis. The new year also renews the hedis healthcare effectiveness data and information set collection period. Aetna better health of new jersey provides initial orientation for newly contracted providers within 180 days after they join our network. Manuals, directories, and training kentucky providers. We created the hedis quick reference guide to help you increase your practices hedis rates and to use to address care opportunities for your patients. Medicare managed care manual centers for medicare and. Please always follow the state andor cms billing guidance and ensure the hedis codes are covered prior to submission. New jersey department of human services division of. Orientation also is available prior to joining our network and before you see members. Our next training begins july 20 th we are a group of experienced doctors and nurses who have devoted our careers to improving the quality of care.

This provider manual is a reference guide for providers and. Below is a monthbymonth breakdown of some of the main activities that a health plan must complete when reporting hedis quality information to ncqa. How to learn hedis in order to apply for jobs quality. Enrollment in abhnj, agnj, hnjh, uhccp, and wchp for core medicaid and managed long term services and supports mltss was 1,677,902 as of 12312016 and 1,650,804 as of 12312017. Nj familycare managed care program in 2016 and 2017. Ncqa accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of hedis, the tool the nation. Online hedis training we offer an online hedis training that will prepare you to be a hedis professional. These are the codes that offer the encounter and claim information needed for payment and measurement of the quality of.

The vendor training is conducted annually in february. Lack of documentation of education and anticipatory guidance. Specifications for the medicare health outcomes survey manual. This manual is intended to be an easytofollow guide that covers the hedis measures applicable to medical and medicare. Next level offers a hedis clinical auditor and abstraction training course. Network news bulletin november 2016 medicare network news bulletin september 2016. The electronic medicaid provider manual contains coverage, billing, and reimbursement policies for medicaid, healthy michigan plan, childrens special health care services, maternity outpatient medical services moms, and other healthcare programs administered by the michigan department of health and human services mdhhs. Now we are here to help you get into the hedis field through this selfpaced online training. Hedis projects are becoming larger and more complex making the organization of work, assigning of abstractors, managing of chart pursuits, and monitoring of overall progress increasingly difficult.

Dec 09, 2014 provides a full overview of how to perform a chart abstraction using clinixmd ehr. Approved reporting changes to the health center program uniform data system uds changes for calendar year cy 2020 the program assistance letter pal 202004 pdf 496 kb provides an overview of approved changes to the health resources and services administrations cy 2020 uds that is reported by health center program awardees and lookalikes by february 15, 2021. Mar 07, 2016 health plan of san joaquin presents its annual hedis training modesto march 24th. We created the hedis quick reference guide to help you. Hedis 2016 summary healthcare effectiveness data and information set hedis is a tool used in the united states to measure performance on important dimensions of care and service. If you are a nurse or other health care professional that has been dying to get into the hedis world and work a hedis project as an abstractor, you can now go through carenationals own training and certification program, hedis certify, taught by kim williams, a certificed professional in. Training for hedis healthcare effectiveness data and information set course starts on. We will ensure that you have access to our newly updated hedis training and would like to offer free access to a friend or family. Hedis is a critical component in how hennepin health measures both the quality and quantity of care.

Reimbursement claims are coded with icd9 diagnosis codes and cpt procedure codes. Hedis 2020 quick reference guide coordinated care health. Visits must be with a pcp and assessment or treatment of an acute or chronic condition do not count towards the measure. Set hedis measures and a pharmacy quality alliance pqa measure.

Appendix 1 hybrid and administrative hedis measures and required documentation. Training for hedis is not a school or educational center and dose not provide any ceus credits. Pcp hedis quick reference guide for primary care providers hedis measure measure requirements recommended services adult bmi assessment aba hybrid measure patients 18 to 74 years old have a documented weight and calculated bmi in 2015 or 2016 bmi z68. Coordinated care strives to provide quality healthcare to our membership as measured through. Updated to refect ncqa hedis 2020 technical specifcations. As the developer of hedis, ncqa offers training on collecting hedis data, hedis annual updates, hedis measures, and best practices for improving hedis results. Some measures, such as cervical cancer screening, look for services performed up to 5 years prior to the reporting year. The training is selfpaced and can be done in the comfort of your home.

If you are interested in participating and becoming hedis nurse expert. The following measures in the hedis quick reference guide are in compliance with the hedis 2019. This provider manual is a reference guide for providers and their staff providing services to members who participate in our medicare advantage andor our medicare advantage special needs program, buckeye. We do not share your information with third parties. This presentation contains content reproduced with permission from hedis volume 2. To learn about optumhealth education or register for classes. Hedis measures relate to many significant public health issues, such as. Hedis 2016, volume 6 all hedis publications are available as easytouse electronic publications epubs, which contain the complete text of ncqa printed publications and are sold by user license. Hedis is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. Hpsj community room, 1025 j street, modesto ca 95354 what.

Take advantage of this guide, coding information, and the online resources to help your practice understand. This may involverecords from more than one provider. Your 2016 guide to key hedis measures keystone first. Well have it back up and running as soon as possible.