Quick reference guide

What is HEDIS?

Healthcare Effectiveness Data and Information Set (HEDIS), is a set of more than 90 standardized performance measures used to annually evaluate and compare the performance of health plans. Data for these measures are collected using administrative/claims information and also Member medical record information. HEDIS results are used to identify opportunities for improving healthcare.

Why is using CPT II codes important?

Using Current Procedural Terminology (CPT II) when submitting claims can help you:

  1. Optimize proper documentation and monitoring care outcomes effectively.
  2. Minimize medical record request and maximize gaps in care closure and interventions.
  3. Improve communication and data capture across different settings of care.

Performance measures and corresponding code lists1:

 Medication reconciliation post-discharge
 Controlling blood pressure
 Diabetes care
 Prenatal and postpartum care

Need additional information?

Contact your provider engagement consultant or the provider service team at 844.440.4629.

1 The list is periodically reviewed for new codes and is accurate as of February 2022.

Updated October 1, 2021