HEDIS Toolkit Booklet

HEDIS 101 For Providers

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is the health care industry’s most widely used set of performance measures. Our NCQA accreditation and provider incentive programs depend, in part, upon this annual evaluation. The New York State Department of Health also requires us to fulfill Quality Assurance Reporting Requirements (QARR). Learn how these data collection efforts may affect your practice.

For an in-depth look at the data collection process and tips on achieving higher HEDIS scores, please log into the CDPHP secure provider portal to access and read our HEDIS Quality Metrics Reference Guidebook.

Behavioral Health Guidelines are Online

CDPHP utilizes both industry-standard and internally developed clinically based medical necessity criteria. The industry-standard behavioral health criteria are Milliman Care Guidelines and ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders. Internally developed criteria are determined based on current industry standards.

• AACAP: Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder

• AACAP: Practice parameter for the assessment and treatment of children and adolescents with tic disorders

• APA: Practice guideline for the treatment of patients with obsessive-compulsive disorder

• American Telemedicine Association: Practice Guidelines for Telemental Health with Children and Adolescents

• American Telemedicine Association: Practice Guidelines for Video-Based Online Mental Health Services

• Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents

• CDC guideline for prescribing opioids for chronic pain - United States, 2016

• Depression in children and young people: identification and management in primary, community, and secondary care

• Institute for Clinical Systems Improvement: Adult Depression in Primary Care

• Milliman Care Guidelines

• TMAP Procedural Manual for Schizophrenia Treatment Algorithms, 2008 

• US Preventive Services Task Force Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement

• VA/DOD: clinical practice guideline for diagnosis and treatment of low back pain

• VA/DOD: clinical practice guideline for the management of major depressive disorder

• VA/DOD: clinical practice guideline for opioid therapy for chronic pain