Quality Initiatives

                                                                             Frequently Asked Questions

Do Consumer Assessment of Health Plans and Systems (CAHPS) and/or Healthcare Effectiveness and Data Information Set (HEDIS) ratings affect claims reimbursement? 

No, CAHPS® and HEDIS® do not currently affect reimbursement. These could, however, become the standards for future quality-based reimbursements.

Does HEDIS count toward durable medical equipment (DME) supplies? 

HEDIS measures do not apply toward DME supplies.

Is HEDIS required for all specialties (example: fertility)? 

HEDIS is not a requirement for specialty practices. Specialty practices, however, can gain NCQA recognition for successfully coordinating patient care with their primary care colleagues. HEDIS does not measure infertility services.

Why does BlueChoice HealthPlan share Gaps In Care (GIC) reports with providers? 

A care gap occurs when a member has not received a preventive health service. We collect and share this data with our providers to have you reach out to those GIC patients to receive those missed and/or undocumented preventive health services. Closing these gaps also help to meet HEDIS requirements while improving the overall health of your patients, our members.

Are specialists expected to report all diagnosis codes for HEDIS? 

No, we do not expect specialists to report all diagnosis codes for HEDIS. Our efforts to close patient care gaps concentrates on claims data from primary care physicians.

How can I receive a GIC Provider Report? 

You can receive your practice’s Gap In Care Provider Detail and/or Summary Reports from your provider advocate. It can be delivered to you securely by email or fax. It is not available via My Insurance Manager at this time.