HEDIS Hybrid Medical Record Review

CalOptima is required to report HEDIS rates to the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Care Services (DHCS). Medical record review is allowed for a subset of measures known as Hybrid Measures.

Each training module contains annual content to help providers and staff understand the specifications and required documentation to meet compliance for each measure while working with CalOptima members. Please review all six modules and share the information with your office staff.

If you have questions or need assistance, please email our team at: HEDISMailBox@CalOptima.org

HEDIS overview For providers and their staff to become familiar with HEDIS process and the hybrid measure specifications.

Well-child measures To help our providers better understand NCQA ‘s specifications for each HEDIS hybrid measure and what documentation we look for when reviewing your medical records.

Weight and BMI assessment measures Review the two measures that assess BMI.

Immunization and lead screening measures Review the immunizations and lead screening measures: Childhood Immunization Status, Lead Screening in Children and Immunizations for Adolescents.

Women’s health measures Review women’s health measures: Cervical Cancer Screening and Prenatal and Postpartum Care.

Adult measures Review the adult measures which include: Colorectal Cancer Screening, Controlling High Blood Pressure, Comprehensive Diabetes Care, Care for Older Adults, Transition of Care, and Medication Reconciliation Post-Discharge.

Near the end of each module, there is a link to a survey to provide feedback to help CalOptima provide meaningful training.