What is HEDIS®?

HEDIS® (Healthcare Effectiveness Data and Information Set) consists of performance measures used by most health plans that compare how a plan performs in quality, access to care, and member satisfaction.

What are the HEDIS® measures and how are they collected?

Measures are collected and calculated using specific CPT and ICD-10 codes found in administrative data (i.e., claims and encounters). For some measures, chart abstractions can be used to supplement the administrative data.

Why is HEDIS® important?

The Alliance wants to ensure that we are offering quality preventive care and service to our members. HEDIS® allows us to monitor how we are performing compared to other health plans and identify areas of opportunity for improvement.

HEDIS® can help you:

  • Monitor patient’s health, prevent further complications and identify issues that may arise with their care.
  • Identify patients who have not received preventive screenings.
  • Understand how you compare with other providers and the national average.

What can you do to improve HEDIS® scores?

  • Make sure that the services are performed in a timely manner and are optimal for patients.
  • Submit any of the valid codes for HEDIS® on an encounter or claim.
  • Document the services and results (if appropriate) in the patient’s medical chart.
  • Encourage your patients to schedule preventive exams.
  • Remind your patients to follow up with ordered tests.
  • Complete outreach calls to patients who have missed services.


If you have questions about HEDIS®, need more information, or would like a copy of the HEDIS® information, please contact: