HEDIS (Health Effectiveness Data and Information Set) was developed by the National Committee for Quality Assurance (NCQA) to measure, report and compare the quality of health plans.  This measurement is accomplished through data collection and analyses both by plan members and individual providers.  

HEDIS data is one of the most widely utilized and comprehensive performance tools in Healthcare.  The purpose of HEDIS data collection is multi-fold:

  1. Quantifies public health issues utilizing standardized measures and domains of care
  2. Compares health plan performance in clinical quality and customer service 
  3. Identifies and eliminate gaps in care by provider and insurance carrier
  4. Individual physician HEDIS scores are used to measure preventive care provided to patients, as well as a means to develop and quantify Physician Incentive programs

Over 90% of carriers utilize HEDIS data, including CMS.  It is extremely important to submit accurate HEDIS data on a timely basis, as NCQA accredited managed care companies perform HEDIS reviews yearly.  HEDIS Compliance can affect potential reimbursement rates:  currently, IPAs utilize these measures to determine fee schedules.   As Value Based Medical Care continues to be developed, HEDIS standards will play a significant role, as these standards measure quality and patient perception of care.  


HEDIS data is collected from Providers in three ways:

    • Medical Records Requests
    • Electronically through the submission of standardized HEDIS CPT II codes which are entered on claim forms
    • Hybrid Method-a combination of the two

Complying with HEDIS medical records requests can be an overwhelming administrative task for an office.  Providing data through claims with standardized HEDIS codes is the most efficient way to report measures, but has been challenging due to the number of measures and correct code selection.


Submission of HEDIS data utilizing standardized CPT II codes is the most efficient way to report HEDIS data.  However, this has been difficult due to the number and specific measures which must be reported.   

Practice Provider has developed a software tool to streamline data collection and ensure accurate HEDIS reporting by your Practice. In addition, utilization of this tool provides an individual report of quality measures by patient to ensure appropriate and timely care is provided to all patients.


  • The software utilizes a set of questions customized for the practice based upon the HEDIS measures which the practice should be reporting
  • The questions have been designed to be easily answered by a medical staff member reviewing the patient encounter, removing the burden of HEDIS reporting from the provider
  • The answers to the HEDIS measure questions are available in a simple drop down format 
  • The software chooses the correct HEDIS CPT II code, and provides the CPT II code for claim reporting.  
  • These codes are then printed out and given to the charge entry personnel to added onto the claim for HEDIS reporting.  
  • A patient dashboard of all HEDIS measures is available to determine gaps in care which can be corrected at the next patient encounter.


PracticeProvider’s HEDIS reporting tool can be instrumental in ensuring the Provider is reporting and obtaining credit for all pertinent HEDIS measures. which impacts reimbursement and quality of care.