HEDIS® Management

Improve Quality Performance, Ensure Compliant Revenue

As a trusted NCQA beta testing partner since 2003, our HEDIS solution sets the standard for efficiency, innovation, ease-of-use, and customer satisfaction. HEDIS reporting enables healthcare organizations to track, monitor, and improve HEDIS® compliance; develop and measure proprietary quality metrics; facilitate NCQA submission; and implement year-round clinical compliance reporting that increases health plan ranking.

Identify gaps in quality and launch patient-level action plans.

Our fully integrated HEDIS solution streamlines compliance and benchmark performance. Clients may choose to leverage either a stand-alone or fully hosted solution suite to increase health plan rankings and ensure appropriate revenue. With tools to analyze claims; collect and abstract medical record data; develop measures; and report to NCQA, our HEDIS Management solution sets the standard for innovation, ease-of-use, and customer satisfaction.

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Boost HEDIS Results with Expert Data Strategies

Fifty percent of NCQA’s Health Plan Accreditation scoring is determined by plans’ HEDIS results. With the number of lives reporting HEDIS data having doubled since 2003, and Health Insurance Marketplace plans required to begin reporting results for more than seven million enrollees in 2015, NCQA’s data set provides more insight into the quality of U.S. healthcare than ever before. From season to season, as the work of HEDIS reporting grows more intensive, we get questions from clients looking for ways to improve their results. We’ve compiled the top questions and answers in our eBrief.

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Record Retrieval

Verisk Health’s process uses proprietary technology to initiate and expedite each request on our clients’ behalf. Medical record requests are filtered through a master record database of over one million provider locations. Retrieved records are scanned into an electronic format, associated to your request, and made available to view or download either directly through the website, or via a secure FTP connection.

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Record Abstraction

Our comprehensive, built-in pursuit and Record Abstraction functionality enables real-time compliance feedback, chart review tracking, and abstraction progress. Coding and abstraction services can be paired with our Quality Reporting software. Verisk Health’s abstraction team is comprised of Registered Nurses and AACP-certified coders with extensive clinical and HEDIS® experience. Our integrated data entry tools feature templates for 19 hybrid measures with real-time compliance feedback and abstraction forms linked to each record within the workflow.

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HEDIS Reporting

HEDIS reporting enables healthcare organizations to track, monitor, and improve HEDIS compliance; develop and measure proprietary quality metrics; facilitate NCQA submission; and implement year-round clinical compliance reporting to increase a health plan’s ranking. With enhanced and customizable capabilities, users can drill into reports at the member, claim, and line-of-business level to ensure accuracy.

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Quality Answers

You may also be interested to learn about the other solution in our Quality Answers suite. Our Quality Answers support clients by driving HEDIS and Medicare Five-Star outcomes. We provide the insight and technology to track and monitor efficiency, improve quality ratings, and ensure compliance with proven solutions and strategies to help you succeed.

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Quality Reporting

Answers to help you measure, improve, and report quality of care against the latest standards.

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Verisk Health offers additional solutions to reduce risk, improve payment accuracy, and ensure appropriate revenue.

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Population Answers

Decision analytics and reporting tools that inform clinical and business strategies.

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Revenue Answers

Solutions to help ensure appropriate revenue.

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Payment Answers

Fraud, waste, and abuse solutions to ensure you pay accurately and contain costs.

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Looking for something more?

Let one of our experts reach out one-on-one and take a shot at answering your specific question.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).