Guidelines

Please review the documents below to achieve the highest quality of care for your patients, our members.

• Provider Tips for Optimizing HEDIS Results Booklet: This booklet will give you a complete list of claim codes and details on each HEDIS measure.
• HEDIS and Quality Management Programs Manual: This manual will give you details on HEDIS and our Quality Management Programs.
• HEDIS Measure Guidelines
  • ADHD Management
  • Adults’ Access to Preventive/Ambulatory Health Services (AAP)
  • Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
  • Breast Cancer Screening (BCS)
  • Colorectal Cancer Screening (COL)
  • Comprehensive Diabetes Care (CDC)
  • Use of Imaging Studies for Low Back Pain (LBP)
  • Pediatrics/Adolescents Management
  • Pharmacotherapy Management of COPD Exacerbation (PCE)
  • Appropriate Treatment for Upper Respiratory Infection (URI)
• Interactive HEDIS Guidelines