Pediatric HEDIS Measures
Click the links below to review guidance on the medical record documentation required to be submitted to close HEDIS care gaps for Children and Adolescents.
| Age | 13 years |
|---|---|
| Documentation required for Gap Closure | Immunization record, documentation from NJIIS, or progress notes with dates, documented name of vaccine and/or illness for:
Combo 1: MCV and Tdap; Combo 2: HPV, MCV and Tdap |
| Product(s) Impacted |
|
| Applicable HEDIS Program | Primary Care Provider |
| Age | On or before 2nd birthday |
|---|---|
| Documentation required for Gap Closure | Lab report, progress note, or NJIIS form indicating lead test, date, and result before the member's second birthday |
| Product(s) Impacted | Medicaid |
| Applicable HEDIS Program | Primary Care Provider |
| Age | 9-26 months |
|---|---|
| Documentation required for Gap Closure | EPSDT (State Contract): 2 lead tests are required as follows:
|
| Product(s) Impacted | Medicaid |
| Applicable HEDIS Program | Primary Care Provider |
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents: BMI Percentile (WCCB)
| Age | 3-17 years |
|---|---|
| Documentation required for Gap Closure | Documentation of height, weight and either of the following:
|
| Product(s) Impacted | Medicaid Commercial |
| Applicable HEDIS Program | Primary Care Provider |
Weight Assessment and Counseling for Nutrition & Physical Activity for Children/ Adolescents: Counseling for Nutrition (WCCN)
| Age | 3-17 years |
|---|---|
| Documentation required for Gap Closure | Documentation must note the date and at least ONE of the following in the measurement year:
|
| Product(s) Impacted | Medicaid Commercial |
| Applicable HEDIS Program | Primary Care Provider |
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents: Counseling for Physical Activity (WCCP)
| Age | 3-17 years |
|---|---|
| Documentation required for Gap Closure | Documentation must note the date and at least ONE of the following in the measurement year:
|
| Product(s) Impacted | Medicaid Commercial |
| Applicable HEDIS Program | Primary Care Provider |
| Age | On or before 2nd birthday |
|---|---|
| Documentation required for Gap Closure | Immunization record or documentation from NJIIS with dates, documented name of vaccine and/or illness for all of the following ON OR BEFORE the child’s second birthday:
|
| Product(s) Impacted | Medicaid Commercial |
| Applicable HEDIS Program | Primary Care Provider |