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The Healthcare Effectiveness Data and Information Set (HEDIS®) was created by the National Committee for Quality Assurance (NCQA) to measure the clinical quality performance of health plans. This is accomplished through the collection and analysis of data documenting the clinical care received by individual plan members from providers, influenced through activities and programs delivered by the health plans. The data is aggregated and reported collectively to reflect the population-based care received by the plan’s membership. These reports have become a major component of quality rating systems that measure the clinical quality performance of health plans.

HEDIS® 2020 includes more than 90 measures across 6 domains of care:

  • Effectiveness of Care.

  • Access/Availability of Care.

  • Experience of Care.

  • Utilization and Risk Adjusted Utilization.

  • Health Plan Descriptive Information.

  • Measures Collected Using Electronic Clinical Data Systems




d3dde9f47c5a5b90aa3ee2eb0bf7585f  The Definition of PCP was Revised (Appendix 1)

d3dde9f47c5a5b90aa3ee2eb0bf7585f  Added a new section, "Referring to HEDIS® Measures and Rates" 

d3dde9f47c5a5b90aa3ee2eb0bf7585f Updated selected value sets to be compatible with digital measure formatting. 

        • Digital measure formatting requires value sets to contain only a single data model category such as diagnosis, encounter, lab test, etc. 

d3dde9f47c5a5b90aa3ee2eb0bf7585f  Updates selected medication lists to be compatible with digital measure formatting. 

        • Medication lists no longer contain variables such as Drug ID, dose, and morphine milligram equivilent (MME) conversion factor. 

        • Lists are now separated and measure specifications describe how to identify "Same or Different Drug" and other data elements required for reporting.

d3dde9f47c5a5b90aa3ee2eb0bf7585f  Added the "Guidelines for the Rules for Allowable Adjustments of HEDIS®"

d3dde9f47c5a5b90aa3ee2eb0bf7585f  Added the "Rules for Allowable Adjustment" to applicable measures



el mirage check mark  Postpartum Depression Screening and Follow-up (PDS)

el mirage check mark  Prenatal Depression Screening and Follow-up (PND)

el mirage check mark  Follow-up After High Intensity Care for Substance Use Disorder (FUI)

el mirage check mark  Pharmacotherapy for Opioid Use Disorder (POD)



x  Standardized Healthcare Associated Infection Ration (HAI)

x Annual Monitoring for Patients on Persistent Medications (MPM)

x  Use of Multiple Concurrent Anti-psychotics in Children and Adolescents (APC)


HEDIS 2020 Timeline



  • The NCQA releases the 2020 Online Healthcare Organization Questionnaire (HOQ) for health plans to request and update submissions.

  • Jan. 31st 

      • Organizations submit completed Roadmap to the auditor by Jan. 31, or at least 2 weeks prior to the onsite visit, whichever is earlier.

      • Auditors will complete the Consumer Assessment of Healthcare Providers and Systems (CAHPA) survey sample frame validation in the HOQ by the end of the month, January 31, 2020.



  • Health plans to finalize commercial, exchange, Medicaid and medicare HOQ requests to obtain access to the Interactive Data Submission System (IDSS) and submission IDs for HEDIS® 1 and CAHPS 2 on February 14, 2020.


MARCH 2020

  • March 1st- Organizations must stop all nonstandard supplemental data collection and entry

  • March 29th- Auditor deadline for approval of all supplemental data


APRIL 2020

  • NCQA releases the 2020 Interactive Data Submission System for data loading and validation.


  • The submission IDs for survey measures are distributed to NCQA certified survey vendors.


MAY 2020

  • Health Plan ratings plan confirmation will process will begin for commercial, Medicaid, and Medicare. Plans must verify the information that will be used to determine how their organization is displayed in the ratings.

  • NCQA certified survey vendors will begin their submission of commercial and Medicaid CAHPS member level data files to NCQA.


  • The NCQA conditions for public reporting letter will be sent to the primary and secondary HEDIS contacts. The letter will include the rules used for displaying data in the public reporting programs, such as the Health Plan ratings.

  • May 8 - Organizations complete MRR abstraction and submit final numerator compliant counts and exclusions to the auditor for MRRV.

JUNE 2020

  • June 15th 

      • The commercial and Medicaid CAHPS survey results will be available for download in the IDSS.

      • The Centers for Medicaid and Medicare requires patient-level-detail file validation for Medicare submissions this month. Organizations must submit the files to CMS vendor by June 15, 2020.

      • Deadline for organizations to submit final, auditor-locked IDSS submissions with attestation to NCQA Deadline for Medicare organizations to submit final, auditor-approved PLD files to CMS

      • The final health plan submission for commercial, exchange, Medicaid, and Medicare HEDIS results into IDSS is due.

      •  Deadline for audit organizations to submit final audit reports to NCQA.

      • Deadline for all attestations to be submitted.

  • June 30th 

      • Last day for IDSS resubmission requests for data and attestations 


JULY 2020

  • NCQA releases the 2020 Quality Compass® commercial edition.




  • Projected Health Plan Ratings for commercial, Medicaid and Medicare are released. Plans are required to confirm their rating and accreditation information (if applicable).




  • Final Health Plan Ratings are posted on NCQA’s Website.

  • NCQA releases the 2020 Quality Compass® Medicare and Medicaid editions.


HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).  https://www.ncqa.org/hedis


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